Excerpt

This guideline provides guidance on the assessment and management of major trauma, including resuscitation following major blood loss associated with trauma. For the purposes of this guideline, major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. This guideline covers both the pre-hospital and immediate hospital care of major trauma patients but does not include any management after definitive lifesaving intervention. It has been developed for health practitioners and professionals, patients and carers and commissioners of health services.

The key clinical areas are:

• Airway management
• Pre-hospital management of chest trauma
• Hospital management of chest trauma
• Management of haemorrhage
• Management of shock
• Heat loss
• Pain management
• Documentation and transfer of information
• Information and support
• Skills to be present in the multidisciplinary team.

Contents

• Guideline Development Group full members
• Guideline Development Group expert members
• Project Executive Team members
• NCGC technical team members
• Acknowledgements
• 1. Foreword
• 2. Introduction
• 3. Development of the guideline
  • 3.1. What is a NICE clinical guideline?
  • 3.2. Remit
  • 3.3. Who developed the trauma guidelines?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Evidence gathering and analysis
  • 4.4. Evidence of cost-effectiveness
  • 4.5. Developing recommendations
• 5. Guideline summary
  • 5.1. Full list of recommendations
  • 5.2. Key research recommendations
• 6. Airway management
  • 6.1. Introduction
  • 6.2. Review question: What is the most clinically and cost effective strategy for managing the airway in patients with trauma pre-hospital?
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Assessment and management of chest trauma
  • 7.1. Introduction
  • 7.2. Pre-hospital chest imaging
  • 7.3. Pre-hospital tension pneumothorax
  • 7.4. Management of open pneumothorax
• 8. In-hospital tension pneumothoraces
  • 8.1. Introduction
  • 8.2. Review question: What is the most clinically and cost effective technique (in-hospital) to manage tension pneumothoraces?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6. Recommendations and link to evidence
• 9. Imaging assessment of chest trauma
  • 9.1. Introduction
  • 9.2. Review question: What are the most clinically and cost effective hospital strategies for assessing chest trauma (tension pneumothorax, haemothorax, cardiac tamponade, pneumothorax, pulmonary contusion, flail chest and aortic injury) in patients with major trauma on initial presentation?
  • 9.3. Clinical evidence
  • 9.4. Review question: Diagnostic accuracy of hospital imaging strategies in people presenting with major trauma
  • 9.5. Clinical evidence
  • 9.6. Economic evidence
  • 9.7. Evidence statements
  • 9.8. Recommendations and link to evidence
• 10. Assessment and management of haemorrhage
  • 10.1. Control of external haemorrhage
  • 10.2. Pelvic binders
  • 10.3. Haemostatic agents
  • 10.4. Anticoagulation reversal
  • 10.5. Haemorrhage shock prediction/risk tools
  • 10.6. Intraosseous (IO)/intravenous (IV) access
  • 10.7. Volume resuscitation
  • 10.8. Fluid replacement
• 11. Control of haemorrhage in hospital
  • 11.1. Haemorrhage protocols
  • 11.2. Haemorrhage imaging
  • 11.3. Whole-body CT
  • 11.4. Damage control surgery
  • 11.5. Interventional radiology
• 12. Monitoring
  • 12.1. Coagulation testing
  • 12.2. Frequency of blood testing
  • 12.3. Lactate levels
• 13. Warming
  • 13.1. Introduction
  • 13.2. Review question: Is warming clinically and cost effective in people who have experienced major trauma?
  • 13.3. Clinical evidence
  • 13.4. Economic evidence
  • 13.5. Evidence statements
  • 13.6. Recommendations and link to evidence
• 14. Pain
  • 14.1. Pain assessment
  • 14.2. Pain management
• 15. Documentation
  • 15.1. Introduction
  • 15.2. Review question: Is documentation using a standard form across all clinical settings (pre-hospital and hospital) in which a major trauma patient might be treated clinically and cost effective?
  • 15.3. Clinical evidence
  • 15.4. Economic evidence
  • 15.5. Evidence statements
  • 15.6. Recommendations and link to evidence
• 16. Information and support
  • 16.1. Introduction
  • 16.2. Review question: What information and support do people with major trauma and their families/carers want in-hospital/on discharge from ED?
  • 16.3. Clinical evidence
  • 16.4. Economic evidence
  • 16.5. Evidence statements
  • 16.6. Recommendations and link to evidence
• 17. Access to the skills required for the management of people with major trauma
  • 17.1. Introduction
• 18. Acronyms and abbreviations
• 19. Glossary
• 20. References
• Appendices A-F
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • References
• Appendices G-I
  • Appendix G. Clinical evidence tables
  • Appendix H. Economic evidence tables
  • Appendix I. GRADE Tables
  • References
• Appendices J-R
  • Appendix J. Forest plots
  • Appendix K. Excluded clinical studies
  • Appendix L. Excluded economic studies
  • Appendix M. Exploration of modelling the time of imaging in Major Trauma
  • Appendix N. TARN: Background and statistical techniques considered for analysis
  • Appendix O. Research recommendations
  • Appendix P. Additional cost effectiveness considerations and costing detail
  • Appendix Q. NICE technical team
  • Appendix R. Qualitative study checklist (per theme)
  • References

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.