Pre-hospital bloods: Using PRANA data to assess the relationship between survivability and pre-hospital blood product administration in major trauma patients

Lay Description

Aims: Patients suffer traumatic injuries caused by incidents like car accidents, assaults and falls every day. Many will be seriously injured and require blood to replenish that lost from a major haemorrhage (bleeding). Blood products have been given by ambulance crews for nearly 15 years and although there is evidence that blood given in hospital improves survival for patients with these serious injuries, there is not enough to prove that it can make a difference when given earlier, i.e. at the time of the injury.

This project aims to use data routinely collected on patients (from PRANA) to see who is most likely to survive if they are given blood products before they come into hospital. These patients will either die on scene or be taken to hospital by ambulance crews. From the data, the study will look at things like the type of injury suffered, patient characteristics (i.e. age, gender) and the treatments they are given (including blood products). It will analyse the data collected to see if there are any patterns in the patients who live or die and whether there is a link between the treatment given or patient characteristics and how long they survive.

As this is a scoping exercise to see if PRANA data can be used for a much larger project, the main aims are to:

• Describe a well-defined group of patients
• Develop a clear summary of available outcomes
• Produce a small survival-focused analysis that is transparent about its limitations.

Describing the cohort, checking data completeness and mapping the patient journey will be incredibly valuable. This initial scoping exercise will establish the feasibility and quality of using linked PRANA data to evaluate pre-hospital blood transfusion, providing the evidence needed to design a robust PhD study. It will also generate insights into the completeness and utility of routinely collected blood data that will be valuable to other organisations, including NHS Blood and Transplant (NHSBT), seeking to improve the evaluation of blood use and patient outcomes.

Public Benefit Statement

Blood transfusions can be life-saving, but they also carry risks and can have side-effects for the person who receives it, so it should only be used where the expected benefit outweighs those risks. Improving understanding of which patients are most likely to benefit could help ensure blood products are used safely and effectively, while also reducing unnecessary use and making better use of NHS resources. The evidence from this study could contribute to developing guidelines for ambulance crews to decide which patients to give blood products to, ultimately resulting in improvements in patient care, both for those who have been injured and for those who selflessly donate their time to give blood.

While there will be no immediate impact on patient care, this first stage of work is important in showing how PRANA’s linked data can be used to answer clinically important questions. It will help inform the design of future research to improve understanding, strengthen safeguards for patients and improve clinical decision making for patients who require administration of pre-hospital blood products. The long-term goal is to use PRANA data to interrogate records from hundreds, if not thousands, of patients who have suffered major traumatic bleeding.