Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review

Helen Nicholson; Natalie Scotney; Simon Briscoe; Kim Kirby; Adam Bedson; Laura Goodwin; Maria Robinson; Hazel Taylor; Jo Thompson Coon; Sarah Voss; Jonathan Richard Benger

doi:10.1136/bmjopen-2023-073075

Factors that influence the administration of tranexamic acid (TXA) to trauma patients in prehospital settings: a systematic review

BMJ Open. 2023 May 31;13(5):e073075. doi: 10.1136/bmjopen-2023-073075.

Authors

Affiliations

¹ College of Health, Science and Society, University of the West of England, Bristol, UK helen5.nicholson@uwe.ac.uk.
² Research, Audit and Quality Improvement Department, South Western Ambulance Service NHS Foundation Trust, Exeter, UK.
³ Exeter HS&DR Evidence Synthesis Centre, University of Exeter Medical School, Exeter, UK.
⁴ Department of Health and Social Sciences, University of the West of England, Bristol, UK.
⁵ College of Health, Science and Society, University of the West of England, Bristol, UK.
⁶ Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
⁷ NIHR CLAHRC South West Peninsula, University of Exeter, Exeter, UK.

Abstract

Objective: In the UK there are around 5400 deaths annually from injury. Tranexamic acid (TXA) prevents bleeding and has been shown to reduce trauma mortality. However, only 5% of UK major trauma patients who are at risk of haemorrhage receive prehospital TXA. This review aims to examine the evidence regarding factors influencing the prehospital administration of TXA to trauma patients.

Design: Systematic literature review.

Data sources: AMED, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index-Science, Embase and MEDLINE were searched from January 2010 to 2020; searches were updated in June 2022.

Clinicaltrials: gov and OpenGrey were also searched and forward and backwards citation chasing performed.

Eligibility criteria: All primary research reporting factors influencing TXA administration to trauma patients in the prehospital setting was included.

Data extraction and synthesis: Two independent reviewers performed the selection process, quality assessment and data extraction. Data were tabulated, grouped by setting and influencing factor and synthesised narratively.

Results: Twenty papers (278 249 participants in total) were included in the final synthesis; 13 papers from civilian and 7 from military settings. Thirteen studies were rated as 'moderate' using the Effective Public Health Practice Project Quality Assessment Tool. Several common factors were identified: knowledge and skills; consequences and social influences; injury type (severity, injury site and mechanism); protocols; resources; priorities; patient age; patient sex.

Conclusions: This review highlights an absence of high-quality research. Preliminary evidence suggests a host of system and individual-level factors that may be important in determining whether TXA is administered to trauma patients in the prehospital setting.

Funding and registration: This review was supported by Research Capability Funding from the South Western Ambulance Service NHS Foundation Trust and the National Institute for Health Research Applied Research Collaboration South West Peninsula.

Prospero registration number: CRD42020162943.

Keywords: ACCIDENT & EMERGENCY MEDICINE; Systematic Review; TRAUMA MANAGEMENT.

Publication types

Review
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Antifibrinolytic Agents* / therapeutic use
Emergency Medical Services* / methods
Hemorrhage / drug therapy
Humans
Tranexamic Acid* / therapeutic use

Substances

Tranexamic Acid
Antifibrinolytic Agents