Assessing the potential for major trauma transfusion guidelines in the UK

Abstract

Background: Major trauma patients are invariably received in the emergency department by a combination of emergency department and trauma team staff. The initial assessment is largely protocol led, using Advanced Trauma Life Support (ATLS) guidelines. The task of ordering and prescribing blood products often falls to the more junior members of this team. Aim: The aim of this postal questionnaire survey was to quantify the use of transfusion guidelines for major trauma in the UK and to assess whether generic national guidelines might be beneficial. Methods: A questionnaire was sent to all major emergency departments in the UK with an attendance .50 000 patients per year (total = 167). A reminder was sent to all non-responders. Each trust was asked whether guidelines are used; which blood products are specified; how useful they consider them to be; and how well they are adhered to. Results: 109 questionnaires (65%) were returned, of which only 17 (16%) currently use major trauma transfusion guidelines. While few trusts currently use guidelines, those being used were found to be very similar. Each trust was asked how useful their guidelines are, using a linear score of 0 to 5 (mean score 3.7). Those without guidelines were asked how useful they thought major trauma guidelines would be (mean score 3.3). Conclusion:The appropriate ordering and use of blood products has major clinical and cost implications. Few trusts currently have guidelines for major trauma despite being enthusiastic regarding their use. The authors propose there is now a role for national major trauma transfusion guidelines within the UK.Major trauma patients comprise a vulnerable group, often requiring rapid treatment plans despite invariably having complex medical demands. Their optimal transfusion requirements have been the topic of much recent research and debate, particularly relating to the use of individual blood products. To date, this work has not been combined to produce generic national guidelines.The aim of this postal questionnaire study was to quantify the proportion of major emergency departments in the UK using trauma transfusion guidelines and consider whether the introduction of generic national major trauma transfusion guidelines could be beneficial.

Blood transfusion and the anaesthetist: management of massive haemorrhage

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Indicators and Effects of Blood Transfusion in Surgically Treated Urology Patients

“…It comes with inherent challenges that make it necessary to only use it where other resuscitative measures would not yield the desired outcome [1][2][3][4]. Apart from the fact that there are very few studies on blood use in urological surgery, we realized that our hospital, like a number of others in the world [5,6] has no transfusion protocol. We present our findings on the principal indicators and the effects of blood transfusion in surgically treated urology patients in a tertiary centre in the Western part of Kenya in the understanding that these will not only fill the void in this area of study but also constitute a basis for protocols on transfusion in hospitals.…”

Emergency department staff knowledge of massive transfusion for trauma: the need for an evidence based protocol

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