BARNES Trauma Research
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Transcript of BARNES Trauma Research
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Trauma Research
Stephen L Barnes MD FACS
Professor of Surgery & AnesthesiaChief, Division of Acute Care SurgeryUniversity of Missouri School of Medicine
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One in 5 trauma deaths potentially salvageable
Chest Injuries and Death from Hemorrhage
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Methodology of most studiesBad
Benefit of HEMS could not be determined
5 studiesBenefit ; 4 Studies No Benefit
Needs standardized reporting structures
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Faster inter-facility transport times
HEMS offered no mortality benefit
Must Identify which patients gain benefit
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1,555,944 Subjects
Age > 65
SBP < 110 more sensitive, less
specific
10 fold increase in mortality
Recommend SBP < 110 mmHg
as highest level of Alert forTriageResource Utilization
NTDB 11-12
ISS > 15
ICU Admit
Urgent OR
ED Death
AUC for SBP < 110
AUC for SBP < 90
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PCC with FFP
Not on Warfarin
Rapid reversal of TIC
Reduced overallneed for blood
products
PRBCs
FFP
Reduced Overall
Cost
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TXA admin within 3
hours of injury
Reduce mortality No increase in
Thrombotic events
No Benefit in
patients with isolatedTBI
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Conclusions:
Use of rFVIIa in the
early management of
TBI is not associatedwith improvement in
mortality or morbidity
and may negatively
impact recovery andfunctional status
Multicenter Trial
11 Level 1 TCs
4284 patients
129 rFVIIa within 24hours
Older male patients
More Warfarin use Higher ISS and Head
AIS
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Conclusions:
Rate of aerodigestive
injury is low Routine bronchoscopy,
esophagoscopy not
warranted
Selective workup
Single Center 2007-
2012
9,946 patients 258 (2.6%)
pneumomediastinum
4 (1.6%) withAerodigestive injuries
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ROC Consortium
19 EMS Systems
10 Hospitals
6 Regions
192 patients
Crystalloid for SBP
