M. Driban1, F. N. Dissak-Delon2, R. Oke3, C. Umoh3, C. Juillard3, A. Chichom-Mefire2, S. Christie3 1University Of Pittsburgh, School Of Medicine, Pittsburgh, PA, USA 2University of Buea, Data Science Center For The Study Of Surgery, Injury, And Equity In Africa (D-SINE-Africa), Buea, SOUTHWEST REGION, Cameroon 3University Of California – Los Angeles, Program For The Advancement Of Surgical Equity, Department Of Surgery, Los Angeles, CA, USA
Introduction:
Early administration of tranexamic acid (TxA) has been shown to reduce mortality in injured patients at risk for hemorrhagic shock in diverse trauma settings including low- and middle-income countries (LMIC). However, lack of granular data on injury in many LMIC has limited understanding of real-world utilization, administration triggers, and outcomes. As part of a larger effort toward development of a context-appropriate hemorrhagic shock protocol, we evaluated practice patterns of TxA administration and outcomes in a critically-injured multi-site trauma registry cohort in Cameroon.
Methods:
The Cameroon Trauma Registry collects ongoing prospective data on patients admitted for injury at ten hospitals throughout Cameroon. TxA was available and administered at all sites. From 2022-23, data were extracted on all enrolled patients at least 16 years of age. Patients were excluded if they lacked vital signs on presentation. Demographics, injury characteristics, physiologic and laboratory parameters, and outcomes were compared between cohorts who received and did not receive TxA. Logistic regression was used to evaluate administration triggers and associations between TxA administration and patient outcomes.
Results:
Of 5,636 trauma patients, 876 patients (15.5%) met CRASH-2 TxA administration criteria (presentation within 8 hours of injury, systolic blood pressure (SBP)<90 or heart rate (HR)>110). Only 1.4% (79 patients) of the overall cohort received TxA: 98.6% did not receive TxA (no-TxA). Mean time to TxA administration was 181 minutes. Only 9 TxA patients met CRASH-2 criteria; the remaining 867 patients meeting CRASH-2 criteria did not receive TxA. TxA patients were more frequently male than no-TxA patients (p=0.01) (Table). There were no significant differences in injury severity, mechanism, vital signs, GCS, external bleeding, or hemoglobin. A higher proportion of TxA patients received colloid (15.2% vs 4.9%, p<0.01) and blood (15.2% vs 2.9%, p<0.01) compared to no-TxA patients. There were no emergency department deaths in the TxA cohort and overall mortality was similar between cohorts (7.6% TxA vs. 6.0% no-TxA, p=0.56). Mortality rate was higher in CRASH-2 patients not receiving TxA (9.9%) than the rest of the trauma population (5.3%) (p<0.01). Logistic regression identified male sex (OR 2.5, 95% CI 1.2-5.2) as the only clinical variable significantly associated with TxA administration.
Conclusion:
TxA administration triggers in Cameroon vary considerably from the inclusion criteria published in CRASH-2, likely decreasing effectiveness of TxA in saving lives after injury. Standardizing administration criteria and provider training could improve resource utilization and reduce trauma death in Cameroon.
