In our study of trauma patients across BC, 35% of eligible patients received a dose of TXA in the pre-hospital setting. This rate is higher than others cited in previous studies. A centre in BC found a pre-hospital administration rate of 19% for their patients, while another centre in Ontario had an intra-hospital administration rate of 27% [8, 9]. There is still potential to further increase administration rates, but some factors may limit the ability to give TXA such as poor intravenous accessibility, time constraints from heavy workloads, or short trips to the hospital. Longer trips to the hospital may allow for more time for paramedics to administer TXA—patients who received TXA, on average, arrived at a hospital 14 min later.
We noted that no patients received TXA beyond the 180-min window [2, 3]. The longest time it took to administer TXA after injury was 140 min, which was documented in interior BC. These results are reassuring in that patients receiving TXA were treated within the recommended time frame, regardless of location, improving their chances for survival [2,3,4,5].
From a quality assurance perspective, the observed association between higher paramedic certification levels with greater rates of TXA administration highlights a potential gap in training regarding TXA and its indication in trauma. This association, however, may be confounded by the likelihood that paramedics of higher certification levels are predisposed to scenarios with more trauma and more overt indications for TXA.
This study is limited by its design as a health records review with a relatively small sample size across the province. As a result, we were unable to evaluate the potential mortality difference between the two groups or assess the safety outcomes associated with TXA. In addition, because nearly all patients with isolated head injuries were not given TXA, our observed administration rate appears low, suggesting an opportunity for education after CRASH-3’s publication .
Based on the existing literature, this is the first study of its kind to focus solely on pre-hospital utilization of TXA. In light of TXA’s implementation into paramedics’ scope of practice, this quality assurance study provides the first province-wide overview of when and how paramedics have been administering it, and whether TXA administration has differed in the diverse communities of BC . The next step to improving administration rates is to determine appropriate interventions and then evaluate their effects in a future study.