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  • 1
    Online Resource
    Online Resource
    Prehospital Tranexamic Acid Administration in Pediatric Trauma Patients: A Propensity-Matched Analysis of the Israeli Defense Forces Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Pediatric Critical Care Medicine Vol. 24, No. 5 ( 2023-05), p. e236-e243
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 24, No. 5 ( 2023-05), p. e236-e243
    Abstract: Tranexamic acid (TXA) administration confers a survival benefit in bleeding trauma patients; however, data regarding its use in pediatric patients are limited. This study evaluates the prehospital treatment with TXA in pediatric trauma patients treated by the Israel Defense Forces Medical Corps (IDF-MC). DESIGN: Retrospective, cohort study using the Israel Defense Forces registry, 2011–2021. PATIENTS: Pediatric trauma patients less than 18 years old. We excluded patients pronounced dead at the scene. INTERVENTIONS: None. SETTING: All cases of pediatric trauma in the registry were assessed for treatment with TXA. Propensity score matching was used to assess the association between prehospital TXA administration and mortality. MEASUREMENTS AND MAIN RESULTS: Overall, 911 pediatric trauma patients were treated with TXA by the IDF-MC teams; the median (interquartile) age was 10 years (5–15 yr), and 72.8% were male. Seventy patients (7.6%) received TXA, with 52 of 70 (74%) receiving a 1,000 mg dose (range 200–1,000 mg). There were no prehospital adverse events associated with the use of TXA (upper limit of 95% CI for 0/70 is 4.3%). Compared with pediatric patients who did not receive TXA, patients receiving TXA were more likely to suffer from shock (40% vs 10.7%; p 〈 0.001), sustain more penetrating injuries (72.9% vs 31.7%; p 〈 0.001), be treated with plasma or crystalloids (62.9% vs 11.4%; p 〈 0.001), and undergo more lifesaving interventions (24.3% vs 6.2%; p 〈 0.001). The propensity score matching failed to identify an association between TXA and lesser odds of mortality, although a lack of effect (or even adverse effect) could not be excluded (non-TXA: 7.1% vs TXA: 4.3%, odds ratio = 0.584; 95% CI 0.084–3.143; p = 0.718). CONCLUSIONS: Although prehospital TXA administration in the pediatric population is feasible with adverse event rate under 5%, more research is needed to determine the appropriate approach to pediatric hemostatic resuscitation and the role of TXA in this population.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000003202
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2070997-3
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  • 2
    Online Resource
    Online Resource
    Freeze dried plasma for the resuscitation of traumatized pediatric patients: Response
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Trauma and Acute Care Surgery Vol. 88, No. 6 ( 2020-6), p. e152-e153
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 6 ( 2020-6), p. e152-e153
    Type of Medium: Online Resource
    ISSN: 2163-0763 , 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000002599
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2651313-4
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  • 3
    Online Resource
    Online Resource
    The Israel Defense Forces experience with freeze-dried plasma for the resuscitation of traumatized pediatric patients
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Trauma and Acute Care Surgery Vol. 87, No. 6 ( 2019-12), p. 1315-1320
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 87, No. 6 ( 2019-12), p. 1315-1320
    Abstract: With the growing recognition of the disadvantages of crystalloid- and colloid-based resuscitation and the advantages of using blood products as the preferred resuscitation fluid, the Israel Defense Forces Medical Corps (IDF-MC) adopted plasma as the primary volume resuscitation regimen in 2013. While data are accumulating for prehospital plasma transfusion, little to no data exist regarding using plasma as a prehospital resuscitation fluid for traumatized pediatric patients. METHODS All patients treated by the IDF-MC personnel are recorded in the IDF Trauma Registry, a unique prehospital trauma registry. All patients treated by the IDF advanced life support providers with FDP at the point of injury between April 2013 and June 2018 who were younger than 18 years at the time of injury were included. RESULTS Six hundred seventy-nine children were treated by IDF medical providers, of whom 33 (5%) were identified in the IDF Trauma Registry as having received FDP at the point of injury. Most patients (80%) were treated for penetrating injuries. Most patients received one plasma unit. Fifty-four percent of the patients were also treated by Tranexamic Acid (TXA) and 48% were transfused with crystalloids. In 33% of patients, additional life-saving interventions were performed. CONCLUSION While the ideal resuscitation fluid for the pediatric population remains to be determined, it seems reasonable to pursue a similar approach to that of applied that for adults. In the IDF-MC, the resuscitation fluid of choice for trauma patients in hemorrhagic shock is freeze-dried plasma transfused at the point of injury. The current study demonstrates the feasibility of FDP administration in the prehospital scenario for injured children and further supports the growing confidence in the use of FDP for the treatment of pediatric trauma patients. LEVEL OF EVIDENCE Retrospective descriptive study, level IV.
    Type of Medium: Online Resource
    ISSN: 2163-0763 , 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000002477
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 4
    Online Resource
    Online Resource
    Prehospital blood transfusion programs : Capabilities and lessons learned
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Trauma and Acute Care Surgery Vol. 82, No. 6S ( 2017-06), p. S70-S78
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 82, No. 6S ( 2017-06), p. S70-S78
    Type of Medium: Online Resource
    ISSN: 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000001427
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 5
    Online Resource
    Online Resource
    Trends in combat casualty care following the publication of clinical practice guidelines
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Trauma and Acute Care Surgery Vol. 91, No. 2S ( 2021-8), p. S194-S200
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 91, No. 2S ( 2021-8), p. S194-S200
    Abstract: The current study explores the trends in the application of combat casualty care following the publication of clinical practice guidelines (CPGs) in five domains for 13 years. METHODS The Israel Defense Forces Trauma Registry was used to assess practice and adherence to guidelines in five domains: ( a ) crystalloid transfusions, ( b ) tranexamic acid use, ( c ) freeze-dried plasma use, ( d ) chest decompression, and ( e ) airway management. All patients injured between January 2006 and December 2018 were included in the analysis. Trends were analyzed and presented monthly using linear regression and were compared using the Chow test. RESULTS The mean ± SD crystalloid volume transfused decreased from 1,179 ± 653 mL in 2006 to 466 ± 202 mL in 2018 ( B = 0.016, 0.006–0.044). The proportion of patients with an indication treated with tranexamic acid dropped from 8% (238 of 2,979 patients) to 2.5% (60 of 2,356 patients) following the stricter guideline's publication. Freeze-dried plasma administration in indicated casualties rose from 12.5% in 2013 to 48% in 2018 ( B = 1.63, 1.3–2.05). The overall proportion of casualties undergoing chest decompression rose from 1% (61 of 6,036 casualties) to 1.5% (155 of 10,493 casualties) following the release of a new CPG in 2012 ( p = 0.013). There were no significant trends in intubation ratios before ( B = 0.987, 0.953–1.02) or after 2012 ( B = 10.2, 0.996–1.05). CONCLUSION Some aspects demonstrate the desired trends in response to new CPGs; in others, initial improvement is achieved but followed by stagnation. In some medical care aspects, completely unexpected and undesirable trends are observed. Every change and update in CPGs should be based on reliable data. The effect of every change must be monitored carefully to ensure adequate adherence to lifesaving guidelines. LEVEL OF EVIDENCE Epidemiological study, level IV.
    Type of Medium: Online Resource
    ISSN: 2163-0763 , 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000003280
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
    Online Resource
    Online Resource
    Trends in prehospital pain management following the introduction of new clinical practice guidelines
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Trauma and Acute Care Surgery Vol. 91, No. 2S ( 2021-8), p. S206-S212
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 91, No. 2S ( 2021-8), p. S206-S212
    Abstract: Early pain treatment following injury has been shown to improve long-term outcomes, while untreated pain can facilitate higher posttraumatic stress disorder rates and worsen outcomes. Nonetheless, trauma casualties frequently receive inadequate analgesia. In June 2013, a new clinical practice guideline (CPG) regarding pain management was introduced in the Israel Defense Forces (IDF) Medical Corps, recommending oral transmucosal fentanyl citrate (OTFC) and low-dose intravenous (IV)/intramuscular ketamine. The purpose of this study was to examine trends in prehospital pain management in the IDF. METHODS All cases documented in the IDF trauma registry between 2008 and 2020 were examined. This study compared casualty parameters before and after the introduction of analgesia CPG in 2013. Parameters compared included demographics, injury parameters, treatment modalities, and types of analgesia provided. RESULT Overall, 5,653 casualties were included in our study. During the 6 years before the introduction of the CPG, 289 (26.7%) of 1,084 casualties received an analgesic treatment, compared with 1,578 (34.5%) of 4,569 casualties during the 7 years following ( p 〈 0.001). Since its introduction, OTFC was administered to 41.8% of all casualties who received analgesia and became the most used analgesic drug in 2020 (61.1% of casualties receiving analgesia). The rate of IV morphine significantly decreased after 2013 (22.6–16%, p 〈 0.001). CONCLUSION Pain management has become more common in trauma patients’ prehospital care in the IDF in recent years. There has been a significant increase in analgesia administration, with the increased use of OTFC, along with a significant reduction in the use of IV morphine. These results may be attributed to introducing a pain management CPG and implementing OTFC among medical teams. The perception of OTFC as a safe user-friendly analgesic may have contributed to its use by medical providers, increasing analgesia rates overall. LEVEL OF EVIDENCE Therapeutic/care management, level III.
    Type of Medium: Online Resource
    ISSN: 2163-0763 , 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000003287
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2651313-4
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  • 7
    Online Resource
    Online Resource
    Prehospital administration of freeze-dried plasma, is it the solution for trauma casualties?
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Trauma and Acute Care Surgery Vol. 83, No. 4 ( 2017-10), p. 675-682
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 83, No. 4 ( 2017-10), p. 675-682
    Type of Medium: Online Resource
    ISSN: 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000001569
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 8
    Online Resource
    Online Resource
    Airway and ventilation management strategies for hemorrhagic shock. To tube, or not to tube, that is the question!
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Trauma and Acute Care Surgery Vol. 84, No. 6S ( 2018-6), p. S77-S82
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 84, No. 6S ( 2018-6), p. S77-S82
    Abstract: Many standard trauma management guidelines advocate the early use of endotracheal intubation (ETI) and positive pressure ventilation as key treatment interventions in hemorrhagic shock. The evidence for using these airway and ventilation strategies to manage a circulation problem is unclear. The potentially harmful effects of drug-assisted intubation and positive pressure ventilation include reduced cardiac output, apnea, hypoxia, hypocapnea (due to inadvertent hyperventilation), and unnecessarily prolonged on-scene times. Conversely, the beneficial effects of spontaneous negative pressure ventilation on cardiac output are well described. Few studies, however, have attempted to explore the potential advantages of a strategy of delayed intubation and ventilation (together with a policy of aggressive volume replacement) in shocked trauma patients. Given the lack of evidence, the decision making around how, when, and where to subject shocked trauma patients to intubation and positive pressure ventilation remains complex. If providers choose to delay intubation, they must have the appropriate skills to safely manage the airway and recognize the need for subsequent intervention. If they decide to perform intubation and positive pressure ventilation, they must understand the potential risks and how best to minimize them. We suggest that for patients with hemorrhagic shock who do not have a compromised airway and who are able to maintain adequate oxygen saturation (or mentation if monitoring is unreliable), a strategy of delayed intubation should be strongly encouraged. LEVEL OF EVIDENCE Review article, level IV.
    Type of Medium: Online Resource
    ISSN: 2163-0763 , 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000001822
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 9
    Online Resource
    Online Resource
    The need for optimized crystalloid-based resuscitation
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Trauma and Acute Care Surgery Vol. 82, No. 6S ( 2017-06), p. S66-S69
    Details
    In: Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 82, No. 6S ( 2017-06), p. S66-S69
    Type of Medium: Online Resource
    ISSN: 2163-0755
    URL: Article
    DOI: 10.1097/TA.0000000000001426
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2651313-4
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  • 10
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    Online Resource
    Fresh whole blood transfusion capability for Special Operations Forces
    CMA Impact Inc. ; 2015
    In:  Canadian Journal of Surgery Vol. 58, No. 3 ( 2015-06-1), p. S153-S156
    Details
    In: Canadian Journal of Surgery, CMA Impact Inc., Vol. 58, No. 3 ( 2015-06-1), p. S153-S156
    Type of Medium: Online Resource
    ISSN: 0008-428X
    Uniform Title: EN
    URL: Journal
    URL: Article
    DOI: 10.1503/cjs
    DOI: 10.1503/cjs.012614
    Language: Unknown
    Publisher: CMA Impact Inc.
    Publication Date: 2015
    detail.hit.zdb_id: 2026595-5
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