Written by Rebecca DiFabio and Ketan Patel
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ACEP has published a revised clinical policy on adult blunt trauma patients, addressing whole-body CT, the geriatric population, blood product ratios, and REBOA.
The quick and dirty on blunt trauma: 4 primary recommendations
Four critical questions regarding adult, non-pregnant blunt trauma patients were addressed in the most recent Clinical Policy. In adult patients presenting to the ED with blunt trauma:
- Does whole-body CT improve clinically important outcomes in hemodynamically stable patients?
Utilize clinical judgment and hospital-specific protocols to decide between selective and whole-body CT imaging (Level C). - Does age-based, differential trauma triage for geriatric patients reduce morbidity and/or mortality?
Emergency physicians should factor age (>65 years) into triage of older adult patients with trauma as they have increased morbidity and mortality compared with similarly injured adults (Level B). The National Guidelines for the Field Triage of Injured Patients in 2021: Recommendations of the National Expert Panel on Field Triage recommends care in a trauma center in patients aged >65 years with a systolic blood pressure <110 mmHg or greater than pulse rate. - What is the ideal blood product ratio in patients requiring transfusion?
Utilize a fresh frozen plasma: platelet: packed red blood cells ratio from 1:1:1 to 1:1:1.5 to reduce 24-hour mortality without increasing morbidity (Level B). The Eastern Association for the Surgery of Trauma additionally recommends an equal ratio of blood products when performing damage control resuscitation. - Does REBOA reduce morbidity and/or mortality in arrested or peri arrest patients compared to ED thoracotomy?
REBOA over ED thoracotomy is not recommended (Level B).
How will this change my practice?
In short, it won’t. The first 2 guidelines heavily rely on utilizing gestalt in the evaluation of trauma patients. This is in line with the standard of care we provide at our level 1 trauma center. As for the 1:1:1 blood product ratio, this has been the preferred ratio since I’ve been in practice, so it’s nice to see it included in the ACEP guidelines. Notably, all the studies used to support the guidelines were level III studies (and the first guideline had no studies, thus relying on expert consensus), so further studies with stronger support will be something to look forward to in the future.
Source
Clinical Policy: Critical Issues in the Evaluation of Adult Patients Presenting to the Emergency Department With Acute Blunt Trauma. Ann Emerg Med. 2024 Oct;84(4):e25-e55. doi: 10.1016/j.annemergmed.2024.05.027. PMID: 39306386
