Jacob Steinmetz

Background: Prehospital administration of blood products is a growing practice. We aimed to describe clinical parameters and mortality following prehospital blood component therapy with red blood cells (RBC) and/or plasma in patients with traumatic and non‐traumatic haemorrhage. Methods: An retrospective cohort study was performed on patients receiving prehospital transfusion products at the Danish national Helicopter Emergency Medical service between 2014 and 2020 with addition of a recent period 2023–2024. Data was collected from relevant data bases and electronic patient journals and analysed descriptively and statistically. Results: We identified 393 patients who received prehospital transfusion (280 trauma and 113 non‐trauma). Prehospital transfusion rate was low (0.9% of missions) with no change during the period studied. Mortality rates for the entire cohort were 13% at 24 h and 26% at 30 days. Trauma patients were significantly younger 49 (IQR; 28–68) vs. 71 (IQR; 60–77)), with lower Glasgow coma score scale; 3 (IQR; 3–14) vs. 15 (IQR; 3–15) and more days on ventilator; 3 (IQR; 1–8) days vs. 2 (IQR; 0–3) days), in intensive care; 5 (IQR; 2–12) days vs. 2 (IQR; 0–4) days) and longer hospital stay 16 (IQR; 6–38) days vs. 8 (IQR; 3–16) days). Lactate trauma‐group: 3.2 (IQR; 1.9–5.8), non‐trauma: 5.1 (IQR; 2.3–9.4) mmol/L and base excess trauma‐group: −4.9 (IQR; −9 to −2.3), non‐trauma: −8 (IQR; −15.6 to −4) mmol/L were outside reference range indicating circulatory shock at hospital arrival while standard coagulation parameters were normal or near‐normal. Mortality was significantly higher in non‐trauma patients as compared with trauma (11% vs. 22%, p = 0.04). Conclusion: Prehospital transfusion was uncommon, did not change over time and was associated with biochemical parameters near the normal reference range. Twenty‐four‐hour mortality was higher among non‐trauma patients compared with trauma patients. Editorial Comment: Some forms of advanced care can be delivered to critically ill or injured patients on their way emergently to hospital, for example in air ambulances. In this cohort of cases which included significant haemorrhage, administration of component blood products was analysed for associations with case conditions and health outcomes.

The Danish Drowning Cohort has collected nationwide prehospital data on fatal and non-fatal drowning incidents in Denmark. The database contains 47 variables: 22 variables from the existing Utstein Drowning Template and 25 additional variables based on the availability in the Danish prehospital medical records. This study aimed to estimate the availability of data (ie, data completeness) for the predefined prehospital registry variables in the Danish Drowning Cohort and the availability of Utstein variables in the subpopulations of drowning patients with and without out-of-hospital cardiac arrest (OHCA). This study included all fatal and non-fatal drownings in the Danish Drowning Cohort from January 1, 2016, to December 31, 2023. Data availability rates were reported for all variables in the Danish Drowning Cohort and the Utstein variables in the subpopulations of patients with and without OHCA, presented as medians with interquartile ranges (IQR). A total of 1,664 drowning patients were analysed (697, 42% with OHCA). The median data availability rate in the Danish Drowning Cohort was 100% (IQR: 88–100%): 100% (IQR: 81–100%) for non-OHCA and 100% (IQR: 87–100%) for OHCA patients. Among the subset of 22 available Utstein variables, the overall data availability was 95% (IQR: 75–100%). For the 17 Utstein variables applicable to both non-OHCA and OHCA, the availability rate was 92% (IQR 76–100%) in non-OHCA cases and 88% (IQR 78–100%) in OHCA cases, with no difference between groups. Overall, 21 of 79 (26%) Utstein variables were unavailable in the Danish setting. The Danish Drowning Cohort contained nationwide data on fatal and non-fatal drowning patients with high degrees of availability. Data availability was high for most variables defined in the Utstein Drowning Template, both for drowning patients with and without OHCA. However, 21 of 79 Utstein variables were unavailable despite the Danish high-resource healthcare setting.

Background: Trauma is a leading cause of death and disability in young adults. Although supplemental oxygen is recommended early after trauma to prevent hypoxemia, evidence regarding the occurrence and distribution of hypoxemic episodes, to raise awareness on potential clinical implications, is sparse. The aim of this study was to investigate the occurrence and daily distribution of hypoxemia within the first day of admission after trauma using continuous pulse oximetry. Methods: Adult trauma patients admitted through the trauma centre at Rigshospitalet, Denmark, between February 20 and August 24, 2024, were included in this observational study irrespective of subsequent admission department. Arterial oxygen saturation measured by pulse oximetry (SpO ₂ ) was continuously monitored for 24 h to identify clinically relevant hypoxemic episodes, defined as SpO ₂ < 90%, for > 5 min. The incidence of episodes was compared regarding the occurrence between daytime and nighttime. Hypoxemic episodes were hypothesized to be more frequent during nighttime. Results: Among 165 included participants, data from 155 were analyzed. Median age was 49 years (IQR 31–62), 74.8% were male, and median Injury Severity Score was 13 (IQR 9–19). In total 146 episodes were recorded, and both daytime and nighttime periods showed incidence rates of 5.1 episodes per 100 participant‐hours, yielding an incidence rate ratio (IRR) of 1.01 (95% CI, 0.73–1.4; p = 0.95) between daytime and nighttime. No differences between daytime and nighttime were found in cumulative hypoxemia duration, prolonged hypoxemic episodes, or across hospital locations. Conclusion: On average, 5.1 clinically relevant hypoxemic episodes occurred per 100 participant‐hours of continuous SpO ₂ monitoring during the first 24 h of hospitalization following trauma. The study found similar incidence rates of clinically relevant hypoxemic episodes at daytime and nighttime. Editorial Comment: Supplementary oxygen is recommended in the early phase after trauma to prevent hypoxaemia. This single center study confirmed that clinically relevant hypoxaemic episodes occur on average five times per 100 participant‐hours during the first 24 h of hospitalization following trauma, with similar incidences during both day and night. The study highligths the importance of continuous monitoring of peripheral oxygenation including if trauma patients are transferred from high‐depency units to the wards. Trial Registration: ClinicalTrials.gov : NCT06256692

Background: Traumatic injury is a leading cause of death and disability worldwide. Advances in acute trauma care have improved survival rates, shifting the focus towards long‐term outcomes and the role of rehabilitation in recovery. Although rehabilitation is clearly defined by the World Health Organisation, substantial variation exists in both clinical practice and in the scientific literature. This scoping review will systematically map the literature on rehabilitation after moderate‐to‐severe traumatic injury and identify potential knowledge gaps to guide future research and clinical practice. Methods: The scoping review will follow the Joanna Briggs Institute Methodology and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews. Eligible studies must explore rehabilitation services delivered by healthcare professionals across any healthcare setting along the trauma care pathway for adults (≥ 18 years) with moderate‐to‐severe traumatic injury. A systematic literature search will be conducted in MEDLINE, Embase, PsycINFO, The Cochrane Library, and CINAHL. Screening and data extraction will be performed independently by two reviewers using Covidence, with disagreements resolved by consensus. Results: Descriptive characteristics of the included studies with data items (study characteristics, participant demographics, rehabilitation approach, care setting, reported outcomes, and key findings) will be summarised in a tabular form. A narrative synthesis will be conducted supported by visual representation to illustrate research patterns and highlight knowledge gaps. Conclusion: This scoping review will provide an overview of existing literature on rehabilitation after moderate‐to‐severe traumatic injury and identify key areas where further research is needed.

Heterogeneity and confounding in the TRAUMOX2 randomised clinical trial—a reply

Background: Informed consent is a fundamental part of clinical research involving human participants. However, in certain emergency medical situations, participants are unable to provide prospective informed consent before inclusion, or the urgency of the situation deems it non‐futile to await consent before the intervention. This has led to the introduction of legal guardians who can provide proxy consent initially, where the legal guardian, next‐of‐kin, and the participant themselves later can give or withdraw consent regarding continued follow‐up. Prior to the initiation of an emergency trial in Denmark, it has been accepted and approved by national or regional research ethics committees, as well as The Danish Medicines Agency if it is a drug study. Objective: The objective of this systematic review is to first identify all conducted emergency trials in Denmark and then contact the researchers of those trials through a national survey. This will serve as the basis for providing a systematic evaluation of the consent procedures and how they are utilized in emergency setting trials in Denmark through both quantitative and qualitative data. Methods: This protocol describes a two‐phase study, consisting of a systematic review identifying all emergency trials in Denmark throughout the different iterations of legislation, and a national survey regarding the use of proxy consent in the trials identified in the systematic review. An information specialist will generate the search string to identify all relevant trials by searching relevant databases. These trials will have data extracted, and the corresponding authors of the trials will be contacted and invited to conduct a survey. This survey will contain quantitative questions about the amount of included participants and to what extent consent was either denied or not obtained. Furthermore, an anonymized section of the questionnaire will investigate qualitatively the opinions, suggestions, and beliefs of the emergency researchers regarding the consent procedures.

Background: The Danish Prehospital Medical Record (DPMR) represents a pioneering nationwide electronic prehospital medical record system. While routinely collected data from the DPMR are increasingly used for research, a comprehensive description of its system and content is needed. Objective: To provide an overview of the DPMR as a tool for research, including its structure, variables, and current volume of records. Methods: We examined the DPMR’s history, data structure, content, and data usage. We also analyzed aggregated DPMR data from 2016 to 2023 for selected key variables. Further, we searched MEDLINE to identify studies utilizing this data source in the past decade. Results: Since 2016, the DPMR system has grown to include 1.8 million unique prehospital patients with over 6 million associated patient contacts. For each patient contact, the DPMR compiles information on the emergency medical call (dispatch criteria, level of urgency, and pre-arrival treatment), characteristics of the incident (patient examination, treatment, response time, on-scene time, and transport time), emergency medical services units (ambulances, rapid response vehicles with paramedics, anesthesiologists in ground-based mobile emergency care units and/or helicopters, or patient transports without treatment capability), and extensive patient-related data. The system currently encompasses 528 variables, standardized across all emergency medical services units. There are a limited number of studies on the data quality of the system and the proportion of patients with missing civil registration numbers has varied between approximately 5% and 9%, which should be taken into account when using it for research. Conclusion: The DPMR is growing in importance as a research tool in Denmark. It provides nationwide patient-related and logistical prehospital data going back to 2016, enabling linkage with national registries for outcome research. Plain Language Summary: We conducted this study to provide a detailed description of the Danish Prehospital Medical Record (DPMR) that can help researchers plan future studies. The DPMR is a nationwide system used in ambulances and other medical emergency units in Denmark to document patient care. Our study examined its structure, data volume, and use in research. Since 2016, it has recorded over six million patient contacts, including details on emergency calls, patient conditions, and prehospital treatments, focusing on individual-level, patient-related data. The description provides researchers with a clearer foundation when designing future studies on patient care before hospital arrival as the DPMR is growing in importance as a research tool in Denmark.