PB0981 - Nationwide analysis of Pre-Hospital Tranexamic Acid in trauma patients at risk of bleeding

Background: Early tranexamic acid (TXA)improves survival in trauma haemorrhage with time to treatment a key determinant of efficacy. UK guidelines are for pre-hospital (PH) medical services to administer TXA within one hour of arrival. Guideline compliance and characteristics of those patients who fail to receive early TXA are unknown.

Aims: Characterise pre-hospital TXA use in trauma to identify undertreated patient subgroups.

Methods: A retrospective analysis of data submitted to the UK Trauma & Audit Research Network by Major Trauma Centres in England & Wales post-regionalization of trauma care (2013-2019). Patients at risk of bleeding and eligible for TXA (best practice tariff guidelines) were identified. Time to administration, injury characteristics and clinical outcomes were analysed. Shock was defined as heart rate ≥110/min and/or systolic blood pressure ≤90 mmHg.

Results: 51,310 patients were included. Overall PH TXA use significantly increased from 8% (2013-15) to 27% (2017-19). In most recent time period, older patients were less likely to receive PH TXA (16-65yrs: 32% vs >65yrs 13%, p< 0.05). Mechanism of injury was associated with significant variation in rates of PH TXA use (gun/knife: 45% vs road traffic collision: 40% vs falls < 2m: 3%). In shocked patients, 54% received PH TXA but significant variation administration persisted across age (16-65yrs: 60% vs >65yrs 34%) and mechanism of injury (penetrating trauma: 65% vs road traffic collision: 70% vs falls < 2m: 11%) subgroups. Average time to TXA for shocked patients was 51 (34-89) mins with 60% receiving TXA < 1hr, and for older shocked patients was 80 (48-154), with only 38% received TXA < 1hr from injury.

Conclusion(s): Early TXA administration in PH care has increased with regionalization of trauma care. Older patients and those with low energy mechanisms of injury are under-treated subgroups who are failing to benefit from early TXA.