Early total care or damage control orthopaedics for major fractures ? Results of propensity score matching for early definitive versus early temporary fixation based on data from the trauma registry of the German Trauma Society (TraumaRegister DGU(®)).

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare that they have no conflict of interest. 5. Trauma Surg Acute Care Open. 2023 Nov 20;8(1):e001160. doi: 10.1136/tsaco-2023-001160. eCollection 2023. Achieving balanced transfusion early in critically bleeding trauma patients: an observational study exploring the effect of attending trauma surgical presence during resuscitation. Gaski IA(1)(2), Naess PA(1)(2), Baksaas-Aasen K(3), Skaga NO(3), Gaarder C(1)(2). Author information: (1)Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway. (2)Institute of Clinical Medicine, University of Oslo, Oslo, Norway. (3)Department of Anesthesiology, Oslo University Hospital Ullevål, Oslo, Norway. BACKGROUND: After 15 years of damage control resuscitation (DCR), studies still report high mortality rates for critically bleeding trauma patients. Adherence to massive hemorrhage protocols (MHPs) based on a 1:1:1 ratio of plasma, platelets, and red blood cells (RBCs) as part of DCR has been shown to improve outcomes. We wanted to assess MHP use in the early (6 hours from admission), critical phase of DCR and its impact on mortality. We hypothesized that the presence of an attending trauma surgeon during all MHP activations from 2013 would contribute to improving institutional resuscitation strategies and patient outcomes. METHODS: We conducted a retrospective analysis of all trauma patients receiving ≥10 RBCs within 6 hours of admission and included in the institutional trauma registry between 2009 and 2019. The cohort was divided in period 1 (P1): January 2009-August 2013, and period 2 (P2): September 2013-December 2019 for comparison of outcomes. RESULTS: A total of 141 patients were included, 81 in P1 and 60 in P2. Baseline characteristics were similar between the groups for Injury Severity Score, lactate, Glasgow Coma Scale, and base deficit. Patients in P2 received more plasma (16 units vs. 12 units; p