Trauma & Orthopaedics

What does STAAMP add to the evidence for prehospital tranexamic acid after trauma? This 2020 appraisal examines the lack of a clear overall mortality benefit, recruitment and power limitations, safety findings and the caution needed when interpreting encouraging timing, shock and dosing subgroups.

Can TEG or ROTEM improve outcomes when added to major haemorrhage care? Natalie May reviews the iTACTIC trial's comparison with conventional coagulation testing, separating faster treatment decisions from demonstrated patient benefit and examining the limits of its size and subgroup findings.

Could intramuscular tranexamic acid be useful when intravenous delivery is difficult? This 2020 review examines a small pharmacokinetic study in trauma patients who had already received IV TXA, distinguishing encouraging absorption data from evidence of improved outcomes or effectiveness as an initial dose.

Does prehospital tranexamic acid improve neurological recovery after moderate or severe head injury? This September 2020 trial appraisal examines the absence of a clear primary-outcome benefit, missing follow-up data, injury severity and how the findings compare with CRASH-3.

A critical tour of trauma research from 2019–20, covering tranexamic acid in head injury, plasma and whole blood, hypocalcaemia and prehospital care. Simon Carley weighs trial findings against the limits of observational evidence, with an additional look at the Zero Point Survey.

Could arginine vasopressin reduce blood-product requirements after major traumatic haemorrhage? This appraisal reviews a small single-centre randomised trial, examining reduced transfusion use alongside the lack of a demonstrated mortality benefit and the limits of applying its findings to a broader trauma population.