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Observational Study
. 2021 Jun 26;16(1):34.
doi: 10.1186/s13017-021-00377-w.

Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

Hiroaki Watanabe  1   2 , Ryo Matsumoto  3   4 , Shunsuke Kuramoto  3   4 , Tomohiro Muronoi  3   4 , Kazuyuki Oka  3   4 , Yoshihide Shimojo  3   4 , Akihiko Kidani  3   4 , Eiji Hira  3   4 , Toshihiko Kawamura  5
Affiliations
Observational Study

Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

Hiroaki Watanabe et al. World J Emerg Surg. .

Abstract

Background: A hybrid emergency room (ER) is defined as an emergency unit with four functions-performing resuscitation, computed tomography (CT), surgery, and angiography. However, the safety and efficacy of performing CT in a hybrid ER are unclear in primary surveys. Therefore, this study aimed to evaluate the safety and clinical effects of hybrid ERs.

Methods: This retrospective observational study used data from the Shimane University Hospital Trauma Database from January 2016 to February 2019. Hospitalized patients with severe trauma and an injury severity score of ≥ 16 were divided into the non-hybrid ER group (n = 134) and the hybrid ER group (n = 145). The time from arrival to CT and interventions and the number of in-hospital survivors, preventable trauma deaths (PTD), and unexpected survivors (US) were assessed in both groups. Further, the amount of blood transfused was compared between the groups using propensity score matching.

Results: The time from arrival to CT and interventions was significantly reduced in the hybrid ER group compared to that in the non-hybrid ER group (25 vs. 6 min; p < 0.0001 and 101 vs. 41 min; p = 0.0007, respectively). There was no significant difference in the rate of in-hospital survivors (96.9% vs. 96.3%; p = 0.770), PTD (0% vs. 0%), and US (9.0 vs. 6.2%; p = 0.497) between the groups. The amount of blood transfused was significantly lower in the hybrid ER group than in the non-hybrid ER group (whole blood 14 vs. 8, p = 0.004; red blood cell 6 vs. 2, p = 0.012; fresh frozen plasma 9 vs. 6, p = 0.021). This difference was maintained after propensity score matching (whole blood 28 [10-54] vs. 6 [4-16.5], p = 0.015; RBC 8 [2.75-26.5] vs. 2 [0-8.5], p = 0.020, 18 [5.5-27] vs. 6 [3.5-7.5], p = 0.057).

Conclusions: The study results suggest that trauma treatment in a hybrid ER is as safe as conventional treatment performed in a non-hybrid ER. Further, hybrid ERs, which can reduce the time for trauma surveys and treatment, do not require patient transfer and can reduce the amount of blood transfused during resuscitation.

Keywords: Blood transfusion; Hemostasis; Hybrid emergency room.

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Conflict of interest statement

Hiroaki Watanabe received lecture fees and travel expenses from Canon Medical Systems for educational lectures in Japan. The rest of the authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion in the study. ER, emergency room; ISS, injury severity score
Fig. 2
Fig. 2
Hybrid emergency room used in this study
Fig. 3
Fig. 3
The amount of blood transfused in both groups. A Whole blood transfusion. B Red blood cell (RBC). C Fresh frozen plasma (FFP). *P < 0.05 for the comparison between the non-hybrid ER and hybrid ER groups
Fig. 4
Fig. 4
The amount of blood transfused in both groups after propensity score matching. A Whole blood transfusion. B Red blood cell (RBC). C Fresh frozen plasma (FFP). *P < 0.05 for the comparison between the non-hybrid ER and hybrid ER groups
See this image and copyright information in PMC

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