Authors: Glen J et al., BMJ 2016 Jun 22; 353:i3051
Early, whole-body computed tomography is emphasized; crystalloid is discouraged.
Sponsoring Organization: U.K.’s National Institute for Health and Care Excellence (NICE)
Target Population: Emergency physicians, surgeons, and other clinicians who care for patients with trauma
Background and Objective
An expert panel commissioned by the U.K.’s National Health Service reported recommendations for assessment and resuscitation of major trauma in the context of a system of care organized by regional trauma networks.
- Use CT early and liberally in adults with major trauma, even omitting plain films and the focused assessment with sonography (FAST) exam in favor of the whole-body scanogram.
- For children <16 years old, do not routinely use computed tomography (CT) as first-line imaging for chest trauma.
- Avoid crystalloid or colloid in patients with suspected major hemorrhage. Use blood instead.
- Except in cases where traumatic brain injury is predominant,use arestrictive transfusion strategy (titrate to mean arterial pressure of 50 mm Hg) until bleeding is controlled.
- Use fixed ratio transfusion protocols (1:1 plasma: red blood cells) until coagulation lab test results are available.
- Use tranexamic acid immediately when there is suspected major bleeding.
- For patients with arterial pelvic bleeding, use interventional radiology techniques in favor of open repair.
These guidelines represent one reasonable alternative to standard U.S. practice. The recommendations are meant for patients with severe trauma and (except for recommendations about tranexamic acid and transfusion ratios) are mostly based on evidence rated as low or very-low quality, or on experience and opinion. Liberal, whole-body CT probably makes sense for patients with a high likelihood of polytrauma or death, but should not be used for every trauma patient, and as these guidelines state, is definitely inappropriate for children.