The Impact of Time to Major Intervention and Delayed Care for Patients with Traumatic Hemorrhage

Abstract

Background: The specific clinical impact of delays to hemostatic intervention in trauma is under-explored. Objectives: Investigate the current understanding of the impact of increasing time to hemostasis and assess its relationship with clinical outcomes. Methods: We conducted a systematic review to characterize existing definitions of delayed hemostasis and its clinical sequelae. We conducted a cohort study of 147 trauma patients to investigate the impact of increased time to hemostasis. Results: Most studies demonstrated significant relationships between time to hemostasis and mortality, despite heterogeneity. The cohort study failed to demonstrate a significant association between time to hemostasis and mortality. Discussion: The thesis has taken steps to investigate time to hemostasis with appropriate methodology. The findings are limited by sample size and confounding by indication. Conclusions: There remains a substantial gap in the literature with respect to understanding the impact of increasing time to hemostasis in trauma and larger studies are needed.