What is the evidence regarding the validity of the 'golden hour' in multi-system trauma?

From the Guidelines

The concept of the "golden hour" in multi-system trauma is supported by the most recent and highest quality study, which emphasizes the importance of prompt decision making and minimizing time to definitive care, particularly for patients with severe injuries requiring surgical intervention 1.

Key Points

• The "golden hour" concept lacks definitive validation from large randomized controlled trials, but observational studies suggest improved outcomes with faster treatment, particularly for patients with severe traumatic brain injury, hemorrhagic shock, or thoracoabdominal injuries requiring surgical intervention.
• Modern trauma systems focus on a continuum of care rather than a rigid timeframe, emphasizing rapid assessment, stabilization, and appropriate triage.
• The "platinum ten minutes" concept highlights the importance of immediate life-saving interventions at the scene, including airway management, hemorrhage control, and rapid transport.
• Hospital preparation through trauma team activation and damage control resuscitation principles, including balanced blood product transfusion with 1:1:1 ratios of packed red cells, plasma, and platelets, are crucial.
• A multicentre cohort study of 198 patients with small bowel injuries following blunt trauma reported a statistically significant correlation between mortality rates and increasing time interval to surgical intervention, highlighting the importance of prompt decision making in all trauma situations 1.

Evidence-Based Recommendations

• Minimizing time to definitive care remains a cornerstone of effective trauma management, with the greatest benefits seen in critically injured patients requiring immediate surgical intervention.
• Trauma teams should prioritize rapid assessment, stabilization, and appropriate triage, with a focus on immediate life-saving interventions at the scene and prompt surgical intervention for patients with severe injuries.
• The use of balanced blood product transfusion with 1:1:1 ratios of packed red cells, plasma, and platelets is recommended as part of damage control resuscitation principles.
• Further research is needed to define the impact of trauma systems and protocols on patient outcomes, including the effect of delayed surgical intervention on morbidity and mortality 1.

From the Research

Validity of the 'Golden Hour' in Multi-System Trauma

The concept of the 'golden hour' in trauma care refers to the critical period immediately after injury when prompt medical intervention can significantly improve outcomes. The evidence regarding the validity of this concept in multi-system trauma is as follows:

• The 'golden hour' is not explicitly mentioned in the provided studies, but the importance of prompt treatment is emphasized 2, 3, 4.
• Trauma-induced coagulopathy (TIC) can occur quickly after trauma, and early intervention is crucial to prevent further complications 2.
• The use of tranexamic acid (TXA) within three hours of injury can reduce mortality and transfusion requirements in trauma patients 2.
• Damage control surgery (DCS) and damage control resuscitation are recommended for patients with severe injuries or at risk of developing the "lethal triad" of haemodilution, acidosis, and hypothermia 2, 3.
• The optimal ratio of blood components in massive transfusion is still a topic of debate, but early administration of plasma, platelets, and red blood cells is recommended 3, 4.

Key Findings

• Early intervention and treatment are critical in multi-system trauma to prevent further complications and improve outcomes 2, 3, 4.
• The use of TXA, DCS, and damage control resuscitation can be beneficial in trauma patients 2, 3.
• The optimal management of bleeding patients requires a multidisciplinary approach and consideration of various factors, including coagulopathy, hypothermia, and acidosis 2, 3, 4.