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1.
Sarthak Sinha Cinthia M. Nuñez Martinez Rebecca L. Hartley Renata J. Quintana Alvarez Grace Yoon Jeff A. Biernaskie Duncan Nickerson Vincent A. Gabriel 《Burns : journal of the International Society for Burn Injuries》2019,45(2):471-478
Objective
Pediatric burns are preventable with legislative and infrastructural changes. Although retrospective audits of many low- and middle-income countries have aided preventative efforts, the epidemiological status of burns in the Caribbean is not known. This study characterizes pediatric burns in the Dominican Republic (DR) and compares these to age-matched North American records captured by the National Burn Repository.Methods
A retrospective audit of 1600 patients admitted to the Unidad de Niños Quemados Dra. Thelma Rosario Hospital, the island’s only major pediatric burn center, between January 2010 to March 2017 was performed. Epidemiological variables analyzed included age, gender, burn mechanism, year, month, city, admission duration, nationality, mortality, and %TBSA.Results
Pediatric burn patients in the DR sustained larger burns (8.2% vs. 6.5% TBSA) and spent more days in the hospital (10 vs. 6 days). Females were overrepresented (M:F = 1:1.5) and mortality amongst admitted patients was 4-fold higher (2.8% vs. 0.7%). Electrical burns were significantly overrepresented in DR (21%) compared to age-matched North American patients (2%). Although electrical burns were smaller (4% TBSA), compared to scald (14% TBSA), and flame (19% TBSA), these burns preferred hands and had a high mortality rate (3%). No significant seasonality in burn mechanisms were observed. Finally, we report geographical and age group differences in the distribution of burn mechanisms and highlight particularly vulnerable subpopulations.Conclusion
This investigation identifies a demographical profile where electrical burns account for a significant percentage of the burn population. This provides a basis for concentrating preventative efforts in vulnerable populations. 相似文献2.
C.M. Legemate H. Goei O.F.E. Gostelie T.H.J. Nijhuis M.E. van Baar C.H. van der Vlies 《Burns : journal of the International Society for Burn Injuries》2019,45(1):88-96
Introduction
During the last decade, the Versajet? hydrosurgery system has become popular as a tool for tangential excision in burn surgery. Although hydrosurgery is thought to be a more precise and controlled manner for burn debridement prior to skin grafting, burn specialists decide individually whether hydrosurgery should be applied in a specific patient or not. The aim of this study was to gain insight in which patients hydrosurgery is used in specialized burn care in the Netherlands.Methods
A retrospective study was conducted in all patients admitted to a Dutch burn centre between 2009 and 2016. All patients with burns that underwent surgical debridement were included. Data were collected using the national Dutch Burn Repository R3.Results
Data of 2113 eligible patients were assessed. These patients were treated with hydrosurgical debridement (23.9%), conventional debridement (47.7%) or a combination of these techniques (28.3%). Independent predictors for the use of hydrosurgery were a younger age, scalds, a larger percentage of total body surface area (TBSA) burned, head and neck burns and arm burns. Differences in surgical management and clinical outcome were found between the three groups.Conclusion
The use of hydrosurgery for burn wound debridement prior to skin grafting is substantial. Independent predictors for the use of hydrosurgery were mainly burn related and consisted of a younger age, scalds, a larger TBSA burned, and burns on irregularly contoured body areas. Randomized studies addressing scar quality are needed to open new perspectives on the potential benefits of hydrosurgical burn wound debridement. 相似文献3.
Soman Sen Luke Hsei Nam Tran Kathleen Romanowski Tina Palmieri David Greenhalgh Kiho Cho 《Burns : journal of the International Society for Burn Injuries》2019,45(1):97-102
Introduction
Following a severe burn injury, significant hematologic changes occur that are reflected in complete blood count (CBC) measurements. Our aim for this study was to examine trend in the components of the CBC in severely burned patients over the first week after injury and compare differences in CBC components between survivors and non-survivors.Methods
A 5-year retrospective review was performed of adult (≥18 years) burn patients with a TBSA ≥ 15%. Age, TBSA, gender, mortality, length of hospital stay, ventilator days, and CBC were collected.Results
Over the first week after injury, HBG and HCT decreased. This decrease was due to loss of red blood cells. WBC counts was initially elevated but decreased over the first 4 days. PLT also decreased over the first 4 days. Non-survivors had lower HBG, HCT, RCC, and PLT over the first week compared to survivors. Non-survivors had higher WBC compared to survivors. RDW was elevated during the first week in non-survivors. MPV was elevated at the end of the first week in non-survivors and MPV on day 7 was independently associated with mortality (O.R. 2.01 (1.1–3.7)). Compared to survivors non-survivors received more transfusions of blood products during the first week after injury.Conclusion
Burn-injury specific trends in CBC measurements can be used as references to determine expected clinical course of burn patients. Non-survivors have early hematologic differences compared to survivors. 相似文献4.
Cheng-I Yen Meng-Jiun Chiou Chang-Fu Kuo Han-Tsung Liao 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1591-1601
Background
Burns are not only major personal catastrophic events but also constitute a national health problem due to its associated morbidity, rehabilitation, mortality and high cost medical services. Advances in care and treatment have increased survival from major burn injury. However, information on the epidemiology and risk factors of burn mortality in Taiwan is limited. The study aim was to determine the nationwide epidemiological characteristics, trends, and mortality risk factors of burn inpatients in Taiwan.Methods
This nationwide population-based study evaluated data retrieved from the Taiwan National Health Insurance database. Patients hospitalized for burns (ICD-9-CM codes 940-949) between 2003 and 2013 were identified from hospitalization records.Results
A total of 73,774 patients were included. The data showed increases in age, revised Baux score, and Charlson Comorbidity Index during the study period, but it was also accompanied by a continuing decrease in burn incidence and a significant shortening of the length of hospital stay. The average in-hospital mortality was 17.5/1000 in 2003 and 12.2/1000 in 2013 but did not showed significant change. Male gender, older age, higher Charlson Comorbidity Index, presence of inhalation injury, large total burn surface area (TBSA), and higher revised Baux score were significant predictors of mortality.Conclusion
Population-based burn epidemiology data demonstrated ongoing improvement in hospital care during the past decade. Male gender, older age, higher Charlson Comorbidity Index, presence of inhalation injury, large TBSA, and higher revised Baux score were significant predictors of mortality. 相似文献5.
Matthew R. McCann William F. Hill Jinhui Yan Sarah Rehou Marc G. Jeschke 《Burns : journal of the International Society for Burn Injuries》2019,45(1):247-252
Objectives
The purpose of this study was to determine whether having a previous diagnosis of multiple sclerosis (MS) changed acute care needs in burn-injured patients.Methods
This was a retrospective case-control study that included adult (aged?≥18 years) patients with an acute burn injury. Control patients were matched with eleven patients with a history of MS at a 4:1 ratio. Outcomes included fluid resuscitation volumes, temperature, heart rate, mean arterial pressure, in-hospital complications, and hospital length of stay (LOS).Results
There were fifty-five patients included and of those, eleven had a documented history of MS. Fluid resuscitation volumes, temperature, heart rate, and mean arterial pressure were similar between groups during the resuscitation period (p > 0.05). LOS was similar between both groups (12, IQR: 2–17 vs. median 16, IQR: 12–21; p = 0.090). However, when normalized to % TBSA burn, patients with MS had a significantly higher median LOS/% TBSA burned (1.2, IQR: 0.7–2.0 vs. 2.1, IQR: 1.1–7.1; p = 0.031).Conclusions
Patients with concurrent burn injuries and MS have a significantly longer LOS/% TBSA burn suggesting that more time is required to heal their wounds. Surprisingly, there were no other significant differences in the after the burn acute phase between these two cohorts. 相似文献6.
Ines A. Ederer Stefan Hacker Nikolaus Sternat Anna Waldmann Olivia Salameh Christine Radtke Reinhard Pauzenberger 《Burns : journal of the International Society for Burn Injuries》2019,45(1):205-212
Background
According to the ABSI – Abbreviated Burn Severity Index – women exhibit an increased risk of succumbing to burn injuries. In contrast, following non-thermal trauma, increased mortality has been shown for the male gender. Therefore, the purpose of this study was to evaluate gender-specific differences among burn patients with special regard to burn mortality.Methods
We retrospectively studied 839 patients who were admitted to the Burn Intensive Care Unit (BICU) and underwent surgical treatment between June 1994 and December 2014. In-hospital mortality was the main clinical endpoint. Odds ratios (ORs) were calculated using univariate and multivariate logistic regression models for the association between sex and mortality.Results
In total, we included 530 male and 309 female burn patients. All patients had at least partial-thickness burns and underwent one or more operative procedures. Women were significantly older than men (mean 60.0 years vs 46.2 years; p < 0.001). Despite having smaller injuries (24.6% vs 30.3% total body surface area (TBSA); p < 0.001), burn mortality among women significantly differed from that of men (27.8% vs 21.7%; OR 1.39, p = 0.045, 95% CI 1.01–1.92). This association, however, did not persist after adjusting for age, %TBSA, inhalation injury and full-thickness burns (OR 1.07, p = 0.77, 95% CI 0.68–1.70).Conclusions
Despite increasing research directed at women’s health, the assoziation between gender and burn mortality has yielded conflicting results. This study does not support a gender-specific difference in burn mortality in our study population. 相似文献7.
8.
Larry M. Jones Nicholas Deluga Puneet Bhatti Scott R. Scrape John K. Bailey Rebecca A. Coffey 《Burns : journal of the International Society for Burn Injuries》2017,43(2):397-402
Introduction
Resuscitation from burn shock using fresh frozen plasma (FFP) has been described. Critics of FFP resuscitation cite the development of transfusion related acute lung injury (TRALI) as a deterrent to its use. This study examines the occurrence of TRALI with FFP resuscitation of critically ill burned patients.Methods
A retrospective chart review was conducted of severely burned patients who received FFP resuscitation. Data points included age, TBSA, TBSA full thickness, presence of alternate etiologies of acute lung injury, total FFP administered, and signs and symptoms of TRALI as defined per the Canadian Blood Services Consensus Conference.Results
Eighty-three patients met the definition of severe burn and received FFP resuscitation. Of those, 65 met exclusion criteria. Eighteen patients were left for analysis with only one found to have signs and symptoms of TRALI. That patient suffered a 53.5% TBSA burn, received a total of 6228 ml FFP, had no competing etiologies of ALI, and was diagnosed with TRALI within 6 h of completing the FFP transfusion.Conclusion
The possible occurrence of TRALI in burn patients receiving FFP resuscitation should be weighed against the reported benefits of such a resuscitation strategy. 相似文献9.
Quan Li Te Ba Ling-Feng Wang Qiang Chen Fang Li Yuan Xue 《Burns : journal of the International Society for Burn Injuries》2019,45(1):140-145
Background
The purpose of the research was to determine the efficacy of the Caprini risk assessment model for the guidance of prophylactic treatments for a 3-year period in the burn center of the Inner Mongolia region.Methods
From July 2014 to August 2017, the Caprini score for every admitted patient was calculated to evaluate venous thromboembolism (VTE) risk. Subjects with a Caprini score between 0 and 2 were not administered a chemical VTE prophylaxis, and subjects with a score of 3 and above were administered low-molecular-weight heparin (LMWH). Demographic information, abbreviated burn severity index (ABSI) score, body mass index (BMI), Caprini score, full-thickness total body surface area (TBSA), overall TBSA, day of ambulation, hospital stay, inhalation injury, electrical burn, central venous catheters, and operations were noted for analysis.Results
Of 1939 inpatients during the study period, 13 patients (0.67%) had VTE complications. The interval from injury to VTE diagnosis was 13.9 ± 8.7 days. Among patients (n = 1131) with a Caprini score between 0 and 2, two patients (0.18%) had VTE. A total of 792 patients received LMWH thromboprophylaxis; 11 patients had VTE complications, and among them, one patient (0.13%) developed heparin-induced thrombocytopenia and two patients (0.25%) developed major bleeding. VTE (8.82%) occurred most commonly in the Caprini score >8 group. Age, Caprini score, ABSI score, overall and full-thickness TBSA, central venous catheters, day of ambulation, and hospital stay in patients with VTE (n = 11) were significantly higher than those (n = 781) without VTE (p < 0.05).Conclusions
Caprini score allows for informed decision-making regarding prophylaxis strategies. Early ambulation and mechanical prophylaxis are recommended for patients predisposed to VTE. 相似文献10.
Atulya Prasad Henry C. Thode Steven Sandoval Adam J. Singer 《Burns : journal of the International Society for Burn Injuries》2019,45(2):348-353
Introduction
Itch after burn injury causes significant distress to patients and can hamper functional recovery. Itching can persist on a time scale ranging from several weeks to even years after injury. In this study, we sought to determine predictors of itching after burn injury.Methods
We compared itch and pain severity among patients included in a burn registry at a level 1 trauma center. Both itch and pain severity was based on a 5-point scale. ANOVA, chi-squared, and multivariate analyses were performed to determine predictors of itch and pain severity.Results
Of the 1159 patients enrolled in the registry, 58% were male and 42% female, with a median age (IQR) of 27 (8–47) years. Most patients were diagnosed with 2nd degree superficial (41%) or deep (43%) burns. Upper extremities were the most common location of burn injury (59%), followed by lower extremities (31%), trunk (22%), and face/neck (20%). More than half (53%) of enrolled patients reported itching, ranging from minimal (19%) to severe (7%) itching. Multivariate analyses revealed age, sex (female), extent of burn injuries, and location (face/neck) to be predictors of itch after burn. Predictors of pain after burn were slightly different: age, extent of burn, and depth of burn.Conclusion
Pain and itch after burn injuries are predicted by slightly different variables, presumably secondary to different underlying mechanisms. We conclude that age, sex (female), extent of burn injuries (total body surface area %), and injuries to the face/neck predict itching of greater severity. Patients with burn injuries that match these parameters would require greater care and closer follow up to reduce itching after healing. 相似文献11.
Stephanie A. Mason Avery B. Nathens James P. Byrne Rob Fowler Alejandro Gonzalez Paul J. Karanicolas Rahim Moineddin Marc G. Jeschke 《Burns : journal of the International Society for Burn Injuries》2017,43(2):258-264
Background
Health administrative databases may provide rich sources of data for the study of outcomes following burn. We aimed to determine the accuracy of International Classification of Diseases diagnoses codes for burn in a population-based administrative database.Methods
Data from a regional burn center’s clinical registry of patients admitted between 2006–2013 were linked to administrative databases. Burn total body surface area (TBSA), depth, mechanism, and inhalation injury were compared between the registry and administrative records. The sensitivity, specificity, and positive and negative predictive values were determined, and coding agreement was assessed with the kappa statistic.Results
1215 burn center patients were linked to administrative records. TBSA codes were highly sensitive and specific for ≥10 and ≥20% TBSA (89/93% sensitive and 95/97% specific), with excellent agreement (κ, 0.85/κ, 0.88). Codes were weakly sensitive (68%) in identifying ≥10% TBSA full-thickness burn, though highly specific (86%) with moderate agreement (κ, 0.46). Codes for inhalation injury had limited sensitivity (43%) but high specificity (99%) with moderate agreement (κ, 0.54). Burn mechanism had excellent coding agreement (κ, 0.84).Conclusions
Administrative data diagnosis codes accurately identify burn by burn size and mechanism, while identification of inhalation injury or full-thickness burns is less sensitive but highly specific. 相似文献12.
13.
Nicola A. Clayton Caroline M. Nicholls Karen Blazquez Cheryl Brownlow Peter K. Maitz Oliver M. Fisher Andrea C. Issler-Fisher 《Burns : journal of the International Society for Burn Injuries》2018,44(8):1997-2005
Background
Management of burns in older persons is complex with evidence indicating advanced age is associated with elevated risk for morbidity and mortality. Dysphagia and its sequelae may further increase this risk.Aims
(1) Determine the prevalence, and (2) identify risk factors for dysphagia in patients admitted with severe burn injury over 75 years.Methods
All patients >75 years admitted to Concord Repatriation General Hospital with severe burn injury over a 4-year period (2013–2017) were assessed for dysphagia on presentation and continually monitored throughout their admission. Burn injury, demographic and nutritional data were captured and analysed for association with and predictive value for dysphagia.Results
Sixty-six patients (35 male; 31 female) aged 75–96 years (median 82 years) were recruited. Dysphagia was identified in 46.97% during their hospital admission. Dysphagia was significantly associated with burn size, pre-existing cognitive impairment, mechanical ventilation, duration of enteral feeding, hospital length of stay, in-hospital complications and mortality. No association was identified between burn location, burn mechanism, surgery and dysphagia. Burn size and Malnutrition Screening Tool score were found to be independent predictors for dysphagia.Conclusions
Dysphagia prevalence is high in older persons with burns and is associated with increased morbidity and mortality, regardless of burn location. 相似文献14.
Anders J. Davidson Sarah-Ashley E. Ferencz Jonathan A. Sosnov Jeffrey T. Howard Jud C. Janak Kevin K. Chung Ian J. Stewart 《Burns : journal of the International Society for Burn Injuries》2018,44(2):298-304
Introduction
The effect of presenting hypertension is poorly studied in combat casualties. We hypothesized that elevated mean arterial pressure (MAP) on presentation to combat hospitals would be associated with poor outcomes.Methods
Data was obtained from the Department of Defense Trauma Registry and the Armed Forces Medical Examiner System. Variables analyzed included presenting vital signs to Role II–III military theater hospital, demographic variables, injury severity score (ISS), location and mechanism of injury, presence of traumatic brain injury (TBI), acute kidney injury (AKI), and mortality. Patients were stratified by decile of MAP and logistic regression analysis was employed to adjust for confounders.Results
A total of 4072 subjects injured from February 2002 to February 2011 were identified. Compared to patients in the middle deciles of presenting MAP, patients in the highest and lowest MAP deciles were the only groups that demonstrated a higher mortality on univariate analysis (OR 2.06, 95% CI 1.16–2.31 and OR 2.86, 95% CI 1.76–4.67, respectively), and this relationship persisted after adjustment for ISS, HR, temperature, presence of burn injury, TBI, and AKI. Burn injury was associated with mortality in the full multivariate analysis. However, further analysis limited to patients without burn injury did not demonstrate an association between high MAP and mortality (OR 0.84, 95% CI 0.36–1.99; p = 0.70). Conversely, when limited to patients with burn injury, high MAP was associated with mortality (OR 3.78, 95% CI 1.74–8.20; p = 0.001).Conclusion
The relationship between mortality and presenting MAP appears to be U-shaped, demonstrating increased mortality in the lowest and highest deciles. However, mortality in the highest MAP decile appears to be limited to casualties with associated burn injury, even after adjustment for TBI, AKI, and ISS, which takes into account the severity of the burn injury. Physicians should recognize that burn patients presenting with an elevated MAP are at an increased risk for poor outcomes.Level of evidence
III. 相似文献15.
Kang Soo Lee So Young Joo Cheong Hoon Seo Joo-Eon Park Boung Chul Lee 《Burns : journal of the International Society for Burn Injuries》2019,45(2):461-465
Objective
The objective of this study is to broaden our understanding of psychiatric disorders due to work-related burn injury compensated by the Industrial Accident Compensation Insurance operated by the Korea Workers’ Compensation and Welfare Service (KCOMWEL).Methods
Using the KCOMWEL electronic database, we collected data on psychiatric disorders due to work-related burn injury based on workers’ compensation records from 2005 to 2014 and analyzed the characteristics of the claims.Results
The average number of claims per year for post-traumatic stress disorder was 67 and the approval rate from 2005 to 2014 was 53.6%. Regarding occupation, 63 workers were elementary workers involved in the performance of simple and routine tasks which may require the use of hand-held tools and considerable physical effort and 59 were electrical and electronic equipment fitters and repairers. Acute stress disorder, nonorganic insomnia, and sexual dysfunction were the most commonly approved psychiatric disorders associated with work-related burn injury, followed by mixed anxiety-depressive disorder.Conclusions
We analyzed the characteristics of the psychiatric disorders due to work-related burn injury for which compensation was received from 2005 to 2014 according to the approved results. To gain a long-term understanding of the management of workers’ compensation status for psychiatric disorders due to work-related burn injuries, we should gather accurate information on the risk factors involved in order to achieve the needed systematic improvements. 相似文献16.
Sarvnaz Sepehripour Sirisha Duggineni Somaya Shahsavari Baljit Dheansa 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1446-1450
Introduction
Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival.Methodology
Retrospective data collection from patients aged 75 with burns injuries, treated and discharged at Queen Victoria Hospital. The Clinical Frailty Scale (Rockwood et al., 2005) was used to calculate frailty at the time of admission. The expected mortality age (life expectancy) of deceased patients was obtained from two survival predictors.Results
The data shows a statistically significant correlation between frailty score and complications and a statistically significant correlation between total body surface area percentage and complications. No significant difference was found between expected and observed age of death or life expectancy amongst the deceased (p value of 0.109).Conclusions
Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population. 相似文献17.
Jacob A. Swann Marc R. Matthews Curt Bay Kevin N. Foster 《Burns : journal of the International Society for Burn Injuries》2019,45(2):494-501
Objective
Native Americans (NAs) have worse healthcare outcomes over some measures than non-Native Americans (non-NAs) (i.e., lower life expectancy, higher heart disease and psychiatric disease rates). Little data exists to show if there are differences in the hospital course of burned NAs versus non-NA patients. The purpose of this study is to analyze the epidemiology, clinical course, and outcomes of NA burn injury in Arizona.Methods
We conducted a retrospective database review of all burn center burn admissions from 2000 to 2015. This initial dataset of 12,724 patients included all initial presentations for burns, non-burns, and readmissions. From this database, we extracted all patients who were new admissions for burn injuries only. This resulted in 10,521 patients of which 9555 patients were non-NA patients and 966 were NA patients. The burn center collects sixty-eight data points to populate our burn database; of these data points, we reviewed twenty-nine to assess if differences existed.Results
Statistically significant differences exist between the two groups with regard to age, geographic locality at time of burn, circumstances surrounding the injury, etiology of the injury, method of transport to the regional burn center, total length of stay, Injury Severity Score on admission, total percent total body surface area burned, month of year of burn injury, hospital charges, payor source for medical costs, and the final disposition. NA burn patients were more often burned at recreational than occupational sites and while participating in non-work related activities. Burn etiologies in NA patients were more frequently due to contact and flame. NA burn patients tended to have greater hospital length of stays and greater charges, and were less likely to be discharged home.Conclusions
Our data demonstrate that NAs have a different experience with the healthcare system than non-NAs after a burn injury. The majority of these issues revolve around socioeconomic differences between the two groups. 相似文献18.
Marion Wiegele Eva Schaden Stefan Koch Daniel Bauer Christoph Krall Dieter Adelmann 《Burns : journal of the International Society for Burn Injuries》2019,45(1):54-62
Background
Severe burns can induce a hypercoagulable state which is not depicted in conventional coagulation assays. The thrombin generation assay allows global assessment of coagulation and can identify hypercoagulability. We report changes in thrombin generation in patients after severe burn injury.Methods
We measured TGA, rotational thrombelastometry and conventional assays in 20 consecutive patients with a total body surface area burned of >20% over a 2-week period: the day after burn trauma (A), the morning after surgical excision of burn wounds (B) and on post-admission days 7 (C) and 14 (D).Results
Thrombin generation assay showed a procoagulatory state: there was an increase in the velocity of thrombin generation (increase in time to peak of +13%, increase in velocity index of +22%), and peak amount of thrombin (+25%) between days A and B. All parameters reached their highest levels on day C and returned towards normal on day D. Rotational thrombelastometry showed a hypercoagulable state with an increase in clot firmness and alpha angle. Conventional coagulation tests remained within reference values.Conclusions
In the first two weeks following burn, both the thrombin generation assay and rotational thrombelastometry show a hypercoagulable state, while conventional coagulation tests remain normal. 相似文献19.
Introduction
Catastrophic haemorrhage is recognised as the leading cause of preventable death in trauma and is also prevalent in medical and other surgical aetiology. Prehospital blood product transfusion is increasingly available for both military and civilian emergency teams. Hospitals have well-established massive transfusion protocols for the resuscitation of this patient group, however the use and impact in the prehospital field is less understood.Aim
To identify and evaluate the current knowledge surrounding prehospital blood product administration for patients with catastrophic haemorrhage.Methods
The integrative review method included systematic searching of online databases Medline, EMBASE, SCOPUS and CINAHL alongside hand-searching for primary research articles published prior to 19 November 2018. Papers were included if the population studied patients with catastrophic haemorrhage who received prehospital transfusion of blood products. The level of evidence and quality was evaluated using the NHMRC hierarchy of evidence. All identified full text articles were reviewed by all authors.Results
Twenty-two papers were included in the final analysis, including both civilian (16) and military (6) practice. The earliest publication for prehospital transfusion was 1999, with increasing prevalence in recent years. Findings were extracted and into two main categories; (1) transfusion processes included team staffing, product selection, and criteria for transfusion and (2) transfusion outcomes; transfusion safety, haemoglobin, hospital intervention and mortality.Discussion
The level of evidence specific to prehospital blood product transfusion is low, with predominantly retrospective methods and rarely sufficient sample sizes to reach statistical significance. Prehospital research is challenged by clinical and logistical variability preventing accurate cohort matching, sample sizes and inconsistent data collection. Evaluation of prehospital transfusion in isolation is also particularly problematic as multiple factors and developments in clinical practice affect patient outcomes and all samples were subject to survival bias.Conclusion The volume and strength of the available evidence prevents accurate evaluation of the intervention and definitive practice recommendations however prehospital transfusion is shown to be logistically achievable and without serious incident. The reviewed evidence broadly supports the translation of recent in-hospital studies, such as PROMTT and PROPPR. Further research specific to prehospital practice is required to guide the development of evidence-based protocols. 相似文献20.
Clifford C. Sheckter Alexander Li Brian Pridgen Amber W. Trickey Yvonne Karanas Catherine Curtin 《Burns : journal of the International Society for Burn Injuries》2019,45(1):146-156