New topic referral exploratory work
Haemostatic dressings
Date of search:
Key terms:
21 August 2013
haemostatic dressing; haemostasis; bleeding; trauma; wound
EndNote database: Not done
Resource
SIGN
NICE (Search using filters for: guidelines,
technology appraisals, diagnostics guidance,
interventional procedures, medical
technologies)
Number of hits
0
3 referred topics may turn out to include
relevant information, not available until 2015
Guidelines International Network (GIN)
0
Cochrane library (Cochrane reviews, DARE,
HTA, NHSEED)
0
UpToDate
3 topics possibly contain some relevant info
ECRI
(Log in, then click HTAIS under Your
Subscription: emerging technology reports,
technology forecasts, evidence reports)
0
Clinical Evidence
EVIDENT
0
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EUnetHTA POP
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Researcher/economist comments:
The checklist sources yielded very little. A Google search identified 2 reviews conducted by
authors in the UK, one systematic (the other’s search was reasonable) summarising pre-clinical
and clinical evidence on relative efficacy of commercially available products including studies in
the civilian setting. These suggest a paucity of published clinical studies (even fewer in civilian
as opposed to military settings) and that the evidence base largely comprises animal studies.
UpToDate includes ‘developing treatments for haemorrhage’ including some haemostatic
dressings…concluding that although some have been used by military personnel few controlled
studies with civilians have been performed and it remains unclear how these products should be
used by civilian emergency clinicians. NICE notes 3 referred topics that may include
haemostasis but the expected publication date is 2015 and the scope is not yet available. I
recommend examination of the content of the 2 reviews and a more detailed scoping search in
selected resources using specific product names, which was not possible in the time available,
to make an adequately informed decision on undertaking further review work on this topic.
Google
Haemostatic dressings would normally be used where compression dressings are unlikely to
stop bleeding or when tourniquet use is not possible, in the event of life threatening traumatic
injury. In particular injuries to the neck, auxilla, groin and perineum.
Smith HA, et al. Haemostatic dressings in prehospital care [review]. Emergency Med J 2012.
http://emj.bmj.com/content/early/2012/11/16/emermed-2012201581.full.pdf+html?sid=b4124309-33fc-4045-ad42-b2611912b362
To some extent this review supersedes the 2010 review, below, as some of the products
included are improved versions of the products reviewed previously. However this is not a
systematic review but an overview of several newer and updated products included in the 2010
review below. The authors conclude that a more robust system of data collection in the field use
of these products is required before they can be adequately assessed for effectiveness.
Granville-Chapman J, et al. Pre-hospital haemostatic dressings: A systematic review. Injury
2010. http://citerahiadesgenettes.hautetfort.com/media/00/01/3315550226.pdf
Included in this review were 6 clinical trials and 37 pre-clinical animal trials. Results show that
several new products (WoundStat, Celox and CombatGauze) outperform the current standard
(HemCon and QuikClot) in recent preclinical trials in some aspects of a prehopsital topical
haemostatic dressing requirement. The clinical evidence comprises retrospective observational
data due to the constraints on conducting trials in the setting in which they are most useful.
Uptodate
Initial evaluation and management of shock in adult trauma, Developing treatments for
haemorrage, including haemostatic agents, including chitosan dressing, Quickclot powder and
fibrin sealant dressing http://www.uptodate.com/contents/initial-evaluation-and-management-ofshock-in-adulttrauma?detectedLanguage=en&source=search_result&search=quickclot&selectedTitle=1%7E1
&provider=noProvider
Fibrin sealant…HaemCon bandage, Chitoflex http://www.uptodate.com/contents/fibrinsealant?source=see_link
Basic principles of wound management, wound dressings
http://www.uptodate.com/contents/basic-principles-of-woundmanagement?detectedLanguage=en&source=search_result&search=haemostatic+dressing&sel
ectedTitle=58%7E150&provider=noProvider#H55268937
NICE
Trauma services: service delivery of trauma services; Status Referred; pub date Oct 2015;
scope not yet available
Major trauma: Assessment and management of major trauma; Status Referred; pub date June
2015; scope not yet available
Complex fractures: Assessment and management of complex fractures; Status Referred; pub
date June 2015; scope not yet available.