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The infusion of packed red blood cells (PRBCs) in the severely injured patient is not a new practice. It is a potentially lifesaving procedure although it is not without inherent risk. This practice in the helicopter emergency medical services (HEMS) has not been examined in the literature. We attempt to determine factors associated with hypothermia (ie,35°C), including the transfusion of O negative blood.This was a retrospective review using our trauma registry on all patients who arrived at our rural level 1 trauma center by HEMS from January 1, 2005, through June 30, 2009. Patient temperature on arrival was compared for patients with and without hypothermia transported by our HEMS service.During the study period, there were 707 HEMS transports by our service. Sixty (8.5%) were hypothermic, and 30 (4.2%) received PRBCs. There was a high likelihood of PRBC patients with hypothermia (odds ratio = 6.27; 95% confidence interval, 2.47-14.89; P.05).HEMS trauma patients who have received blood are more likely to arrive hypothermic (ie,35°C). The clinical impact of giving PRBCs in the HEMS prehospital setting was not determined.

Background—Trauma registries may contain records without a codable trauma diagnosis, creating a “data gap” that multiplies the number of invalid registry data fields. We designed an investigation intended to determine the incidence of registry records with non-codable trauma diagnoses, characterize those records, and determine the reasons for inadequate diagnosis data. Methods—We utilized a retrospective cohort design. A query of trauma registry records spanning a five-year period yielded 129 records with no injury severity score. Each patient’s medical record was reviewed, sources of diagnostic information were noted and diagnoses were categorized. Results—In 57% of cases, we found documentation that the patient had sustained an injury, but the injury was inadequately documented in the discharge summary. In 19% of cases, although the registry record was valid, the diagnosis was not codable as trauma. In 17% of cases, clinical documentation was adequate, but the diagnosis was inadequately recorded in the trauma registry. In 13% of cases, no traumatic injury was sustained, although the registry record was valid. In 2% of cases, the trauma registry record itself was invalid. In 1% of cases, a coding error occurred. Conclusions—Particularly prominent among records with inadequate discharge documentation were cases of head and spine injury for which there was no radiographic evidence. The incidence of records with uncodable diagnoses might best be reduced through improved physician documentation, revision of trauma registry inclusion criteria, increased attention by trauma registrars to key sources of documentation, and direct communication with the attending physician when necessary.

BACKGROUND: Transfusion of plasma and red blood cell (RBC) units in a balanced ratio approximating 1:1 has been shown in retrospective studies to be associated with improved outcomes for trauma patients. Our low-volume rural trauma center uses a trauma-activated transfusion algorithm. Plasma is thawed upon activation to avoid wastage. However, the time required for plasma thawing has made achievement of a 1:1 ratio early in resuscitation challenging. In this study, the time required for plasma thawing is characterized, and a potential solution is proposed. METHODS: A retrospective chart study of 38 moderately and massively transfused (≥6 U in the first 24 hours) trauma patients admitted from January 2008 to March 2012 was performed. We evaluated the time required to dispense plasma and the number of RBCs dispensed before plasma in these patients. RESULTS: The average time between the dispense of RBCs and plasma was 26 minutes (median, 28; range, 0-48 minutes). The average number of RBCs dispensed before plasma was 8 U (median, 7 U; range, 0-24 U). Nearly one third of massively transfused patients had 10 RBCs or greater dispensed before plasma was available. CONCLUSION: There exists the potential for delayed plasma availability owing to time required for thawing, which may compromise the ability to provide balanced plasma to RBC transfusion to trauma patients. Maintenance of a thawed Group AB plasma inventory may not be operationally feasible for rural centers with low trauma volumes. Use of a thawed Group A plasma inventory is a potential alternative to ensure rapid plasma availability. LEVEL OF EVIDENCE: Therapeutic study, level V.

Importance Unnecessary interfacility transfer of minimally injured patients to a level I trauma center (secondary overtriage) can cause inefficient use of resources and personnel within a regional trauma system. Objective To describe the burden of secondary overtriage in a rural trauma system with a single level I trauma center. Design Retrospective analysis of institutional trauma registry data. Setting Dartmouth Hitchcock Medical Center, a rural level I trauma center. Patients A total of 7793 injured patients evaluated by the trauma service at Dartmouth Hitchcock Medical Center from January 1, 2007, to December 31, 2011. Exposure Evaluation by the trauma service. Main Outcomes and Measures Patients transferred from another hospital to Dartmouth Hitchcock Medical Center who did not require an operation, had an Injury Severity Score lower than 15, and were discharged alive within 48 hours of admission. Results Of the 7793 evaluated patients, 4796 (62%) were transferred from other facilities. When compared with scene calls (n = 2997), transferred patients had a similar median Injury Severity Score of 9, but 24% of transferred adult patients and 49% of transferred pediatric patients met our definition of secondary overtriage. The overtriaged patients were most likely to have injuries of the head and neck (56%), followed by skin and soft-tissue injuries (41%). Seventy-two unique institutions transferred trauma patients to Dartmouth Hitchcock Medical Center, but 36% of the overtriaged patients were from 5 institutions. Conclusions and Relevance The incidence of secondary overtriage in our rural trauma center is 26%, with head and neck injuries being the most common reason for transfer. Costs for transportation and additional evaluation for such a significant percentage of patients has important resource utilization implications. Effective regionalization of rural trauma care should include methods to limit secondary overtriage.