Early predictors for massive transfusion in older adult severe trauma patients

BackgroundMany scoring systems for the early prediction of the need for massive transfusion (MT) have been reported; in most of these, vital signs are regarded as important. However, the validity of these scoring systems in older patients remains unclear because older trauma patients often present with normal vital signs. In this study, we investigated the effectiveness of previously described scoring systems, as well as risk factors that can provide early prediction of the need for MT in older severe trauma patients.MethodsWe prospectively collected data from a cohort of severe trauma patients (ISS ≥16 and age ≥16 years) admitted from January 2007 to March 2015. Trauma Associated Severe Hemorrhage (TASH), Assessment of Blood Consumption (ABC), and Prince of Wales Hospital (PWH) scores were compared between a younger and an older group. Furthermore, the predictors associated with MT in older severe trauma patients were assessed using multivariable logistic regression analyses.ResultsThe area under the curve (AUC) was significantly smaller for older group than for younger group for all three scoring systems (p < 0.05). The most important risk factors to predict the need for MT were related to anatomical factors including FAST results (odds ratio (OR): 5.58, 95% confidence interval (CI): 2.10–14.99), unstable pelvic fracture (OR: 21.56, 95% CI: 6.05–90.78), and long bone open fracture of the lower limbs (OR: 12.21, 95% CI: 4.04–39.09), along with pre-injury anticoagulant agent use (OR: 5.22, 95% CI: 1.30–19.61), antiplatelet agent use (OR: 3.81, 95% CI: 1.57–9.04), lactate levels (OR: 1.20, 95% CI: 1.04–1.39) and shock index (OR: 2.67, 95% CI: 1.05–6.84). Traditional vital signs were not early risk factors.ConclusionWe suggest that MT in older trauma patients should be considered on the basis of anatomical factors, pre-injury anticoagulant or antiplatelet agent use, lactate level and SI even if traditional vital signs are normal.     

外伤性肝破裂危险因素分析

目的　分析外伤性肝破裂的危险因素。方法　将 1996～ 2 0 0 1年我院收治的外伤所致的 4 9例肝破裂患者入院时的 13项指标、美国肝脏损伤分级标准、出血量和预后 (并发症的发生率和死亡率 )的关系进行分析。结果　收缩压、脉率、失血量、受伤至就诊时间、肝脏损伤分级 ,是影响肝破裂预后的因素。结论　对影响肝破裂的预后因素应当予以足够的重视 ,以提高临床疗效。     

肝外伤预后因素分析

目的 分析肝外伤的预后因素。方法 选择1999年1月～2003年5月我院收治的63例肝外伤病例进行回顾性分析,将患者入院的10项指标和美国肝外伤分级标准以及伤后出血量和预后的关系进行分析。结果 本组治愈58例,死亡5例,需再次手术4次。手术后发生并发症11例,其中包括呼吸衰竭,切口感染,肺部感染或栓塞,肝胆漏,再出血及粘连性肠梗阻等。结论 对影响肝外伤预后的因素应当给予重视,以提高肝外伤的救治率。     

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure. This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery: modified fenestration with restorative spinoplasty. Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up. Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender, preoperative presence of resting numbness in the leg, drop foot, cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels. However, 27 (30.3%) and 13 (14.6%) patients showed residual leg pain/numbness and gait disturbance, respectively. Among the variables examined, the preoperative resting numbness was associated with residual leg pain/numbness and gait disturbance, and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender. This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent.     

Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients

Introduction

To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population.

Materials and methods

A prospective validation trial was completed at a Level 1 adult trauma centre in Melbourne, Australia. One hundred and fifty four patients with orthopaedic trauma managed or followed-up by an orthopaedic unit were prospectively recruited. Patients with pathological fractures related to metastatic disease and/or an isolated orthopaedic injury, a documented history of mental illness or dementia or those for whom follow-up was likely to be difficult were excluded. The SF-12, SIP and SMFA were administered by a trained interviewer at one and six months. Each questionnaire was scored for the physical and mental components and then compared for content and construct validity at each time point.

Results

Complete data were collected for 134 patients at one and six months. The one and six month component scores correlated strongly between the SF-12 physical, SIP physical (r = 0.513–0.669) and SMFA dysfunction (r = 0.529–0.778); the SF-12 mental, SIP mental (r = 0.643–0.719) and SMFA bother (r = 0.564–0.602) components. The strength of association was greater for the six month time point compared to the one month measure. The SF-12 demonstrated no ceiling or floor effects, and provided a lower time burden on participants and researchers when compared to the SIP and SMFA.

Conclusions

For large population-based surveillance research into orthopaedic injury the SF-12 provides a valid and versatile tool.     

严重肝外伤的诊断与手术策略

目的 探讨严重肝外伤的诊断与治疗方法。方法 回顾性分析1988年1月～2001年12月经手术治疗的69例严重肝外伤患者,对早期诊断及手术方法进行总结。结果 按AAST肝外伤分级,Ⅲ级38例、Ⅳ级20例、Ⅴ级11例,伴合并伤41例(51．9％),均手术治疗。治愈57例(82．6％),死亡12例(17．4％),死亡原因为术中失血性休克3例．术后继发出血3例,MODS4例,脑疝2例。结论 诊断性腹穿,B超、CT以及血液动力学是诊断严重肝外伤的基本方法,综合手术治疗是救治严重肝外伤的重要手段。     

严重肝外伤的伤情特点及外科治疗选择

目的 分析严重肝外伤的伤情特点,探讨不同手术方式的治疗效果.方法 总结分析10年来收治的109例严重肝外伤临床资料.采用肝周纱布堵塞术5例,清创加缝合术32例,清创性肝切除术59例,规则性肝切除术13例.结果 109例中治愈92例,病死17例.病死病例中包括Ⅲ级5例,Ⅳ级9例,V级3例;其中单纯肝损伤3例(17.6%);伴合并伤14例(82.4%).结论 严重肝外伤以右肝严重损伤为主,多伴合并伤,需紧急救治.根据不同伤情采取最适宜的手术方式是提高救治成功率的关键.     

Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients

BackgroundThe influence of alcohol on the outcome after major trauma remains controversial. In several recent studies, alcohol has been associated with neuroprotective effects in head injuries, while others reported negative or no effects on survival and/or the in-hospital stay in major trauma patients (TP). The purpose of this study was to examine the relationship of alcohol with injury characteristics and outcome as well as to analyze possible anti-inflammatory properties in major TP.Patients/methods184 severely injured TP with an Injury Severity Score (ISS) ≥16 were successively enrolled. All patients had measured blood alcohol concentration (BAC). Patients were grouped according to their positive BAC (>0.5‰, BAC) vs. <0.5‰ alcohol (no BAC) upon arrival at the emergency department (ED). Injury characteristics, physiologic parameters and outcome with respect to organ or multiple organ failure (MOF), SIRS, sepsis, pneumonia, ARDS or mortality were assessed. Systemic levels of interleukin (IL)-6 at ED were determined.ResultsForty-nine TP had positive BAC without chronic alcohol abuse history and 135 patients had BAC levels below 0.5‰. Overall injury severity and age were comparable in both groups. No BAC TP received significantly higher numbers of packed red blood cells and fresh frozen plasma (transfused within the initial 24 h or in total) compared to BAC TP. Organ failure, MOF, SIRS, sepsis, pneumonia, ARDS and the in-hospital mortality were not different between both groups. Trauma patients with positive BAC had significantly decreased leukocyte numbers and systemic IL-6 levels compared to no BAC group. There was a significant positive correlation between leukocyte counts and IL-6 as well as BAC and leukocytes. BAC levels did not correlate with IL-6.ConclusionsPositive BAC is associated with reduced leukocyte numbers and lowered systemic IL-6 levels at admittance indicating immune-suppressive effects of alcohol in major trauma patients.     

Outcome prediction in trauma

BACKGROUND: In the Trauma Audit and Research Network (TARN), currently the largest trauma network in Europe, outcome prediction is performed using the TRISS methodology since 1989. Its database contains 200,000 hospital admissions from 110 hospitals over the country, but a large amount of data is lost for the modelling because of missing data. To improve some of the shortcomings of TRISS a new model was developed. METHODS: The data for modelling consisted of 100,399 hospital trauma admissions over the period 1996 to 2001. Using the Glasgow Coma Score (GCS) instead of RTS has dramatically reduced the number of missing cases. Gender and its interaction with age have also been included in the model. The model was tested on different subsets of cases traditionally excluded, such as children, those with penetrating injuries, and ventilated and transferred patients. The new model included all those subsets using age, a transformation of ISS, GCS, gender and gender by age interaction as predictors. RESULTS: The model has shown a good discriminant ability tested by the area under the receiver operating characteristic (AROC) curve. The values of the AROC for the new model were 0.947 (95% CI: 0.943-0.951) on the prediction set and 0.952 (95% CI: 0.946-0.957) on the validation set compared respectively with 0.937 (95% CI: 0.932-0.943) and 0.941 (95% CI: 0.936-0.952) for TRISS. CONCLUSION: The new model has enabled us to include most of the cases that were excluded under the TRISS's inclusion criteria, less missing data are incurred and the predictive performance was significantly better than that of the TRISS model as shown by the AROC curves.     

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of “disc herniation”, less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.     

Staged management and outcome of combined pelvic and liver trauma. An international experience of the deadly duo

Pelvic fracture associated with liver trauma is not an uncommon injury combination in multiple trauma and is associated with high morbidity and mortality. The aim of this study was to examine the characteristics of this specific patient group, to describe the diagnostic and treatment protocols and finally to analyse risk factors associated with mortality. Data were collected over a 6-year period, ending in 2001. The pelvic injury was graded according to the Tile classification system and the hepatic injury was scored using the organ injury scale (OIS). Treatment protocol, associated injuries, complications, length of ICU/Hospital stay and mortality were recorded and analysed. A total of 140 patients (40% female) with a mean age of 35.1+/-15.9 years and a median ISS of 41 were included in this study. The overall mortality rate was 40.7%. Binomial logistic regression analysis revealed age, initial blood pressure, transfusion requirement as well as the severity of head, chest, spleen and liver injury as independent parameters predicting reduced survival rates. This deadly duo of injuries presents a challenge to the trauma surgeon. Rapid assessment and treatment is required to prevent death by haemorrhage. The presence of concomitant injuries renders the patient very sensitive to ongoing or additional physiological disturbance. The principles of 'damage control surgery' must be applied to avoid complications such as acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS).     

The value of an admissions proforma for elderly patients with trauma

The authors worked in a busy regional fracture unit, where it was noted that important data was being omitted from the medical notes. In an attempt to improve on this, an admission proforma was formulated. This was designed to be easily and quickly completed. Notes were audited on 2 separate weeks, the first before, and the second after introduction of the proforma.The overall results demonstrate statistically significant improvements in documentation with a proforma, and concur with the limited previous literature in this area.     

Patients can accurately self-report their elbow range of motion following surgery for trauma

IntroductionThere is an increased demand of telemedicine in the recent century, especially with the outbreak of Covid-19. The aim of this study was to investigate patients' reliability in self-assessing own elbow range of motion following surgery for trauma.MethodsAll patients of age ≥16 years who underwent surgery for elbow trauma at the local trauma unit between March 2015 to Aug 2018 were reviewed retrospectively. Identified cohort was invited to self-assess their elbow range of motion (ROM) using questionnaire with image instruction. They were then followed up with a clinical review for objective measurements by the lead clinician. Independent T-test was used to compare the measurements between patients and clinician. The power of the study was calculated using G1Power software.ResultsThirty-five patients were enrolled in the study with mean age of 41 years. 11 of 35 patients had an associated elbow fracture dislocation associated. Mean patient reported total ROM was 105.7° ± 32.8°, with mean extension of 24.6° ± 18.9° to mean flexion of 130.3° ± 18.2°. Mean objective ROM measured by lead clinician was 112.6° ± 18.3°, with mean extension 22.4° ± 10.9° to mean flexion 135.0° ± 10.8°. No statistical significance was found between self-reported and clinician-based extension (p = 0.36), flexion (p = 0.076), and overall range of motion (p = 0.12).ConclusionPatients can self-assess their elbow range of motion following surgery for trauma accurately. In the midst of increasing demands for telemedicine, we suggest the application of patients' self-reporting outcome in clinical settings.     

Inter-rater agreement on assessment of outcome within a trauma registry

IntroductionTo better evaluate the degree of ongoing disability in trauma patients, it has been recommended that trauma registries introduce routine long-term outcome measurement. One of the measures recommended for use is the Extended Glasgow Outcome Scale (GOS-E). However, few registries have adopted this measure and further research is required to determine its reliability with trauma populations. This study aimed to evaluate the inter-rater agreement of GOS-E scoring between an expert rater and trauma registry follow-up staff with a sample of detailed trauma case scenarios.MethodsSixteen trauma registry telephone interviewers participated in the study. They were provided with a written summary of 15 theoretical adult trauma cases covering a spectrum of disability and asked to rate each case using the structured GOS-E interview. Their ratings were compared with those of an expert rater in order to calculate the inter-rater agreement for each individual rater-expert rater pair. Agreement was reported as the percentage of agreement, the kappa statistic, and weighted kappa. A multi-rater kappa value was also calculated for agreement between the 16 raters.ResultsAcross the 15 cases, the percentage of agreement between individual raters and the expert ranged from 63% to 100%. Across the 16 raters, the percentage of agreement with the expert rater ranged from 73–100% (mean = 90%). Kappa values ranged from 0.65 to 1.00 across raters (mean = 0.86) and weighted kappa values ranged from 0.73 to 1.00 (mean = 0.89) The multi-rater kappa value was 0.78 (95% CI: 0.66, 0.89).ConclusionsSixteen follow-up staff achieved ‘substantial’ to ‘almost perfect’ agreement with an expert rater using the GOS-E outcome measure to score 15 sample trauma cases. The results of this study lend support to the use of the GOS-E within trauma populations and highlight the importance of ongoing training where multiple raters are involved to ensure reliable outcome reporting. It is also recommended that the structured GOS-E interview guide be used to achieve better agreement between raters. Ensuring the reliability of trauma outcome scores will enable more accurate evaluation of patient outcomes, and ultimately, more targeted trauma care.     

损伤控制性手术原则在严重肝外伤治疗中的应用

目的：探讨损伤控制性手术原则（DCS）在肝外伤治疗中的应用价值。
方法：回顾性分析168例III级以上严重肝外伤患者临床资料,按是否实施损伤控制性手术原则分为两组,比较两组在平均手术时间、并发症、病死率以及住院时间方面的差异。
结果：DCS组的住院时间长于一期手术对照组 [（24.5±3.2）d vs.（16.4±4.1）d]（P<0.05）,但其平均手术时间、术后并发症发生率及病死率较对照组明显降低[（102±27）min vs.（224±35）min;26.3% vs. 38.4%;15.8% vs. 30.1%）]（均P<0.05）。
结论：损伤控制性手术原则在肝外伤治疗中对患者是有益的,可降低患者术后并发症及病死率。     

Predictors of outcome after in situ anterior vaginal wall sling surgery

Pubovaginal sling procedures are being performed with increased frequency for stress urinary incontinence. The vaginal wall sling was introduced in 1989 by Raz et al., and itssuccess rate has been reported as being 61%–100%. A number of recent studies have identified that some patient factors may influence the likelihood of a successful outcome. In the present study, we evaluated whether preoperative Valsalva leak-point pressure and urethral pressure profile can be used as predictors of success after surgery. We identified the preoperative characteristics of 58 women who underwent an isolated in situ anterior vaginal wall sling procedure by the same surgeon. Patients' ages, previous anti-incontinence procedures, hormone replacement status and previous hysterectomies were determined and patients underwent urodynamics, including cystometry, measurement of the Valsalva leak-point pressure and urethral pressure profile (maximal urethral pressure). After the vaginal wall sling procedure, success was defined as a significant improvement in stress urinary incontinence symptoms or no symptoms at all.The 58 women ranged from41 to–71 years old (average 52.3) and average follow-up was 26 months (range 16–34). An anti-incontinence procedure had been done previously in 15% of cases. The success rate was 65.4% in patients with Valsalva leak-point pressure < 50 cmH₂Oand maximal urethral pressure < 30 cmH₂O, but it was 90.6% in patients with Valsalva leak-point pressure 50 cmH₂O or higher and maximal urethral pressure 30 cmH₂O or more. Patients with Valsalva leak-point pressure 50 cmH₂O or higher and maximal urethral pressure 30 cmH₂O or more had a 90.6% success rate, and it was significantly higher than the success rate of patients with lower values for both parameters. We concluded that preoperative Valsalva leak-point pressure and maximal urethral pressure can be used to estimate the success rate of anterior vaginal wall sling procedures. When of these parameters are concurrently high, the outcome of surgery seems more favorable.Editorial Comment: It is still controversial whether or not preoperative urodynamic factors can predict a successful outcome after anti-incontinence surgery. The authors feel that 'a VLPP of >50 cm and UPP >30 cm are significant and easily quantifiable preoperative predictors of a successful anterior vaginal wall sling procedure'; however, they do not explain why a VLPP alone is not predictive. The paper differs significantly from a previous publication on this topic (Goldman HB, Rackley RR, Appell RA (2001). The in situ anterior vaginal wall sling: predictors of success. J Urol 166:2259–2262). Further studies on this procedure are needed before any definitive conclusions can be made.     

Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry

Background and aims Since 1999, the Dutch trauma care has been regionalized into ten trauma systems. This study is the first to review such a trauma system. The aim was to examine the sensitivity of prehospital triage criteria [triage revised trauma score (T-RTS)] in identifying major trauma patients and to evaluate the current level of trauma care of a regionalized Dutch trauma system for major trauma patients.Patients and methods Major trauma patients (n=511) (June 2001–December 2003) were selected from a regional trauma registry database. The prehospital T-RTS was computed and standardized W scores (Ws) were generated to compare observed vs expected survival based on contemporary US- and UK-norm databases.Results The T-RTS showed low sensitivity for the prehospital identification of major trauma patients [34.1% (T-RTS≤10)]. Nevertheless, 78.0% of all major trauma patients were directly managed by the trauma center. These patients were more severely injured than their counterparts at non-trauma-center hospitals (p<0.001). No significant difference emerged between the mortality rates of both groups. The Ws {−0.46 calculated on the US model [95% confidence interval (CI) ranging from −1.99 to 1.07]} [0.60 calculated on the UK model (95% CI ranging from −1.25 to 2.44)] did not differ significantly from zero.Conclusion The trauma center managed most of the major trauma patients in the trauma system but the triage criteria need to be reconsidered. The level of care of the regional trauma system was shown to measure up to US and UK benchmarks.     

创伤后早期出现肝功能损伤的临床分析

目的探讨创伤早期出现继发性肝损伤的相关因素,提高对创伤的认识。方法对98例创伤病人入院时的临床资料进行回顾性分析。谷丙转氨酶与收缩压、血糖、ISS评分等依次进行相关分析。根据ISS评分或血糖是否正常或是否发生全身炎症反应综合征(system ic inflamm atory re-sponse syndrom e,SIRS)分组,进行肝损伤发生率的卡方检验。结果创伤早期肝损伤与血糖及ISS评分等成正相关,与收缩压、血红蛋白成负相关。严重创伤病人出现血糖升高和全身炎症反应综合征更易发生肝损伤。结论严重创伤常致肝功能损害,注意保护肝功能,有利于病人康复。     

Evolution, not revolution: splenic salvage for blunt trauma in a statewide voluntary trauma system--a 10-year experience

BACKGROUND: State-legislated trauma systems have been enacted in an attempt to improve trauma care. Blunt splenic injury incidence without a legislated trauma system was examined for changes in care with a hypothesis that a voluntary system may perform equally with a legislated system. METHODS: Data from a statewide discharge database for the years 1993 to 2002 were examined. RESULTS: There were 276,425 trauma admissions overall, with blunt splenic injury occurring in 1.76%. Average Injury Severity Score (ISS) increased in trauma centers and decreased in the community. Trauma centers (TC) had more multisystem injuries. Splenic injury diagnosis increased 44% in TC between the early and late periods but only 7% in community facilities. Splenectomies increased 16% in TC but declined 16% in community hospital. Splenic salvage rate improved at both types of facilities. CONCLUSIONS: Splenic salvage rates improved over time in hospitals with no formal trauma system. Community hospitals cared for more than 50% of splenic injuries but transferred complex multisystem injuries, including splenic injuries, suggesting evolving care. Non-invasive imaging has increased the recognition of splenic injuries in both community hospitals and TC. Splenectomies are performed less, but have increased in TC with increasing ISS scores.     

Emergency thoracotomy as a rescue treatment for trauma patients in Iceland

Objective

Emergency thoracotomy (ET) can be life-saving in highly selected trauma patients, especially after penetrating chest trauma. There is little information on the outcome of ET in European trauma centres. Here we report our experience in Iceland.

Material and methods

This was a retrospective analysis of all patients who underwent ET in Iceland between 2005 and 2010. Patient demographics, mechanism, and location of major injury (LOMI) were registered, together with signs of life (SOL), the need for cardiopulmonary resuscitation (CPR), and transfusions. Based on physiological status from injury at admission, the severity score (ISS), revised trauma score (RTS), and probability of survival (P_S) were calculated.

Results

Of nine ET patients (all males, median age 36 years, range 20–76) there were five long-term survivors. All but one made a good recovery. There were five blunt traumas (3 survivors) and four penetrating injuries (2 survivors). The most frequent LOMI was isolated thoracic injury (n = 6), but three patients had multiple trauma. Thoracotomy was performed in five patients, sternotomy in two, and two underwent both procedures. One patient was operated in the ambulance and the others were operated after arrival. Median ISS and NISS were 29 (range 16–54) and 50 (range 25–75), respectively. Median RTS was 7 (range 0–8) with estimated P_S of 85% (range 1–96%). Median blood loss was 10 L (range 0.9–55). A median of 23 units of packed red blood cells were transfused (range 0–112). For four patients, CPR was required prior to transport; two others required CPR in the emergency room. Three patients never had SOL and all of them died.

Conclusion

ET is used infrequently in Iceland and the number of patients was small. More than half of them survived the procedure. This is especially encouraging considering how severely injured the patients were.