1421 The Scottish Code Red Audit report for the period 1st January 2018 to 31st December 2019 with comparison to previous audit findings of Scottish Code Red practice since 1 June 2013
Authors: Reed Matthew ,   On behalf of the Scottish Transfusion and Laboratory Support in Trauma Group Matthew J Reed Hamish McLay Neil Hughes Niall McMahon Nicola Littlewood Katherine Hands Jennifer Laird Margaret McGarvey April Molloy Claire Mckie Arran Keir Patrick Heard Susan Henderson Eleanor Knight Michael Donald Donna Paterson David Connor Margarita Gonzalez Carla Ferguson Megan Rowley Ross Archibald Andrea J Wolfe Barry Schyma
Published: December 2022

Aims, Objectives and Background

The Scottish Transfusion and Laboratory Support in Trauma Group (TLSTG) have previously audited National Code Red activations to optimise the transfusion support given to patients following major trauma in Scotland. This report is for all patients in Scotland for whom a Code Red was activated between 1st January 2018 and 31st December 2019 and also compares findings to previous audits since 1 June 2013.

Method and Design

A clinical and transfusion lead for each centre entered anonymised data onto a secure electronic database (REDCap).

Abstract 1421 Table 1

Summary data comparison to previous audits

1 June 2013-31 Oct 20151 Nov 2015-31 Dec 20171 Jan 2018- 31 Dec 2019Activations566696Mean age434543Male %758869Mean ISS262831Blunt %757574Received blood products %899390Pre-hospitalPre-hospital transfusions, n164873999 to Code Red activation, mins703780Pre-hospital tranexamic acid, %707893Volume of clear fluid given, mls500285266Emergency DepartmentMean ED arrival SBP, mmHg90104102ED arrival to CRC transfusion, mins9164ED arrival to FFP transfusion, mins505616FBC order to result, mins814648Clotting screen order to result, mins1195314Use of ROTEM / TEG in ED, %01213Volume of clear fluid given, mls1000198Massive transfusion, n(%)7 (13)5 (8)24 (25)Survival to hospital discharge %636665Code Red activation to ED, mins243320CRC units/ patient in first24 hours455FFP units/ patient in first 24 hours444Platelet units/ patient in first 24 hours221Total wasted CRC, n16937Total wasted FFP, n331437Total wasted platelets, n666

Results and Conclusion

There were 96 Code Red activations. Mean age was 43 (SD 18) years, and 66 (69%) were male. Median ISS was 29 (IQR 19–41, n=76, mean ISS 31, SD 17) with 71 (74%) blunt trauma. 87 (90%) received blood components with 73 (76%) receiving pre-hospital transfusion. 67 of 73 (92%) who received pre-hospital transfusion, received further hospital transfusion. Median time from 999 call to Code Red activation was 80 (IQR 56–106, n=47) minutes and 77 (93%, n=93) patients received pre-hospital TXA. Median time after ED arrival to transfusion was 4 minutes (IQR 0–17, n=50) for Concentrated Red Cells (CRC) and 16 minutes (IQR 5–28, n=49) for Fresh Frozen Plasma (FFP). Median time from ED arrival to Full Blood Count (FBC) result was 70 mins (IQR 50–109, n=61) and for clotting was 74 mins (IQR 54–100, n=83). 65 (68%) patients survived to hospital discharge. Activations have increased over the audit periods (audit 1=56, audit 2=66, audit 3=96), with an increased in female% noted this audit. Injury Severity Score (ISS) has increased (26,28,31) as has pre-hospital transfusions (16,48,73), pre-hospital tranexamic acid% (70,78,93), Rotational Thromboelastometry use (0,12,13) and massive transfusion (7,5,24). Time to CRC, FFP, FBC, and clotting results are maintained or improved. CRC (16,9,17 units) and FFP (37 vs 14 units) wastage has increased. Survival% is maintained (63,66, 65)