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Observational Study
. 2024 Jul 22;41(8):452-458.
doi: 10.1136/emermed-2023-213806.

Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis

Camille Girardello  1   2 , Pierre-Nicolas Carron  3   2 , Fabrice Dami  3 , Vincent Darioli  3 , Mathieu Pasquier  3   2 , François-Xavier Ageron  3   2
Affiliations
Observational Study

Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis

Camille Girardello et al. Emerg Med J. .

Abstract

Background: Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The aim of this study was to assess the prehospital administration of TXA for injured patients in a Swiss region.

Methods: We conducted a retrospective observational study in Switzerland between 2018 and 2021. Inclusion criteria were injured patients ≥18 years for whom an ambulance or helicopter was dispatched. The exclusion criterion was minor injury defined by a National Advisory Committee for Aeronautics score <3. The primary outcome was the proportion of patients treated with TXA according to guidelines. The European guidelines were represented by the risk of death from bleeding (calculated retrospectively using the Bleeding Audit for Trauma and Triage (BATT) score). Factors impacting the likelihood of receiving TXA were assessed by multivariate analysis.

Results: Of 13 944 patients included in the study, 2401 (17.2%) were considered at risk of death from bleeding. Among these, 257 (11%) received prehospital TXA. This represented 38% of those meeting US guidelines. For European guidelines, the treatment rate increased with the risk of death from bleeding: 6% (95% CI 4.4% to 7.0%) for low risk (BATT score 3-4); 13% (95% CI 11.1% to 15.9%) for intermediate risk (BATT score 5-7); and 21% (95% CI 17.6% to 25.6%) for high risk (BATT score ≥8) (p<0.01). Women and the elderly were treated less often than men and younger patients, irrespective of the risk of death from bleeding and the mechanism of injury.

Conclusion: The proportion of injured patients receiving TXA in the prehospital setting of the State of Vaud in Switzerland was low, with even lower rates for women and older patients. The reasons for this undertreatment are probably multifactorial and would require specific studies to clarify and correct them.

Keywords: Observational Study; pre-hospital; trauma.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of the study population, Vaud, Switzerland, 2018–2021. BATT, Bleeding Audit for Trauma and Triage; NACA, National Advisory Committee for Aeronautics (score)
Figure 2
Figure 2
Proportion of tranexamic acid (TXA) administration according to the baseline risk of death from bleeding and sex, Vaud, Switzerland, 2018–2021. *P<0.001. BATT, Bleeding Audit for Trauma and Triage.
Figure 3
Figure 3
Number and proportion of patients treated by tranexamic acid (TXA) according to different treatment criteria, Vaud, Switzerland, 2018–2021. *Risk of significant bleeding estimated by the BATT score: Bleeding Audit for Trauma and Triage prognostic model. **US guidelines: systolic blood pressure <90 mm Hg and heart rate >120 bpm.
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References

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