Page 222 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F8.1 Young HA Investigators Session 14:30 Room 421

Improving Outcome with Implementation of the Use of Tranexamic Acid for Traumatic Brain Injury with
Contusions or Traumatic Subarachnoid Haemorrhage in the Elderly
Chan DYC, Tsang ACO, Li LF, Tsang CP, Taw BTB, Cheng KF, Pu JKS, Ho WS, Leung GKK, Lui WM
Department of Neurosurgery, Queen Mary Hospital, Hong Kong

Introduction
Fall with head injury is becoming an epidemic burden especially in the elderly population. One of the contributing factors for
mortality and poor functional outcome in elderly’s moderate head injury is development of cerebral contusion, i.e. delayed
traumatic intracerebral haematoma, or traumatic subarachnoid haemorrhage. The implementation with the use of Transamin
and outcome of this group of patients is not established.

Objectives
To investigate the implementation of the use of Tranexamic Acid (Transamin) in traumatic brain injury with contusions or
traumatic subarachnoid haemorrhage in the elderly.

Methodology
This was a seven-year retrospective study of consecutive patients admitted for traumatic brain injury with contusions or
traumatic subarachnoid haemorrhage at Queen Mary Hospital from 2010 to 2016. Primary outcome was the implementation
rate of Transamin after adaptation of a new Neurosurgery Departmental Protocol in October 2011 at Queen Mary Hospital.
Secondary outcomes included the rate of deterioration requiring operations and the survival rate without operations.

Results
A total of 651 consecutive patients were identified. 81 patients had Transamin (Transamin group) while 570 did not have
Transamin (control group) during admission. The Transamin group was significantly older at 73.92 years old (95%CI 68.77-
77.84 years old) versus 65.36 years old (95%CI 63.24-67.48 years old) for the control group (p=0.0062). The implementation
rate had a strong positive correlation over time with a Pearson Correlation Coefficient of R2 =0.8336 which was significant.
The rate of deterioration requiring operation in the Transamin group was significantly lower at 6.17% versus 16.3% in the
control group (OR 0.337 95%CI 0.133-0.857, p=0.022). The survival rate with no operations in the Transamin group was
significantly higher at 88.89% versus 77.89% in the control group (OR 2.270 95%CI 1.104-4.667, p=0.026).

ConclusionIn this study, patients in the Transamin group was significantly older than the control group. The rise in
implementation was positive and strongly correlated with time. Transamin group had a lower rate of operation. With the use
of Transamin, there were significantly more survivors without operations. Further studies are required to assess the impact of
the use of Transamin on a territory-wide basis.

Tuesday, 8 May 2018

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