United Kingdom’s National Institute for Health and Care Excellence (NICE) recommends the following as guidelines for imaging and transfusion in trauma:
- 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.
A Focused Assessment with Sonography for Trauma (FAST exam) is still recommended for every major trauma patient in the Trauma Bay. This is especially true for unstable major trauma patients who may need to go straight to the OR instead of the CT scan in cases of suspected hemoperitoneum.
These recommendations, meant for patients with severe trauma, represent a reasonable alternative to standard U.S. practice. Except for recommendations about TXA and transfusion ratios, most of the recommendations are based on evidence rated as low or very-low quality or on experience and opinion.
For patients with a high chance of polytrauma or death, liberal, whole-body CT probably makes sense. However, it should not be used for every trauma patient and definitely never for children.
- Glen J et al. Assessment and initial management of major trauma: Summary of NICE guidance. BMJ 2016 Jun 22; 353:i3051. (http://dx.doi.org/10.1136/bmj.i3051)