Compliance with the massive hemorrhage protocol in trauma: a retrospective quality review
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CORRESPONDENCE
Compliance with the massive hemorrhage protocol in trauma: a retrospective quality review Huda Khayyat, MBBS . Jeannie L. Callum, MD, FRCPC . MaryJane Hill-Strathy, BSc . Rachel Strauss, MPH . Lowyl Notario, MSc, RN, ENC(C) . Avery Nathens, MD, MPH, PhD . Luis da Luz, MD, MSc
Received: 3 July 2020 / Revised: 26 August 2020 / Accepted: 1 September 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, Sunnybrook Health Sciences Centre is the largest level 1 trauma centre in Canada, with 2,100 trauma activations per year. Although the trauma literature suggests that massive hemorrhage protocol (MHP) reduces mortality,1 adherence is vital for ongoing success of the MHP. We conducted a retrospective audit of the adherence to our MHP in severely hemorrhaging trauma patients between 1 January 2017 and 31 August 2018. The objective was to determine the overall compliance with the protocol (score: 0–100) and each MHP component. The 11 quality metrics (Table) were developed by committee consensus, tailored to the need of our centre.
There were 96 MHP activations, and 90% of the activations occurred in the trauma bay. Most patients were male (75%). The median [interquartile range (IQR)] age was 41 [25–58)] yr, the injury severity score was C 16 in 91% of patients, and most injuries (70%) were blunt. Ten patients were excluded because the MHP was terminated within 30 min. Satisfactory compliance with the MHP (score C 70) was achieved for 51% of activations. The median [IQR] scores for adequate and inadequate compliance groups were 75 [75–85]% and 55 [50–60]%, respectively. The demographics and clinical characteristics were similar between the two groups.
H. Khayyat, MBBS University of Toronto, Toronto, ON, Canada
L. Notario, MSc, RN, ENC(C) Emergency Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Department of Anesthesia & Critical Care, Faculty of Medicine, King Abdulaziz University, Jedah, Saudi Arabia
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
J. L. Callum, MD, FRCPC Biological Sciences, Trauma, Emergency & Critical Care Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
A. Nathens, MD, MPH, PhD Evaluative Clinical Sciences, Tory Trauma Program, Sunnybrook Research Institute, Toronto, ON, Canada
Department of Laboratory Medicine and Molecular, Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Department of Surgery, University of Toronto, Toronto, ON, Canada
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
L. da Luz, MD, MSc (&) Department of Surgery, University of Toronto, Toronto, ON, Canada e-mail: [email protected]
M. Hill-Strathy, BSc School of Psychology and Neuroscience, University of St Andrews, St Andrews, UK R. Strauss, MPH Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Evaluative Clinical Sciences, Trauma Emergency & Critical Care Research Program, Sunnybrook Research
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