title: Use of rFVIIa in the trauma setting--practice patterns in United States trauma centers.
abstract: Much excitement has been generated regarding the off label use of recombinant factor VIIa (rFVIIa) in the severely injured trauma patient. The purpose of our study is 3-fold: 1) describe the type of centers that use rFVIIa, 2) determine which centers use the drug more frequently, and finally 3) investigate how this drug is being administered at trauma centers. A survey was mailed or e-mailed to 435 trauma centers (Level I and II) throughout the nation. One hundred fifty-six surveys were returned. American College of Surgeons (ACS) verification and trauma Level I designation were independent predictors of rFVIIa use (odds ratio [OR] 3.74 and 5.40, P < 0.05). High users of rFVIIa were defined as those centers that had above median usage of the drug. Level I centers accounted for 67 per cent of the high users. Only the number of fellowship-trained trauma surgeons and trauma volume predicted high usage of rFVIIa (OR 1.38 and 14.09, P < 0.05). Trauma volume predicted whether or not Factor VII users implemented a protocol based approach to administration of the drug (OR 6.57, P < 0.05). Most protocols incorporated packed red blood cells (74%) before giving rFVIIa. The dose of 90 mcg/kg was exceeded in 34 per cent of centers, and 3 per cent used the 200 mcg/kg dose. High volume Level I trauma centers use rFVIIa more frequently and are more likely to use a systematic approach to its administration. However, there is no standardized approach to rFVIIa administration in United States trauma centers.
authors.affiliation: William Beaumont Army Medical Center, Department of Surgery, El Paso, TX 79920-5001, USA. John.Horton2@amedd.army.mil
authors.forename: John D
authors.initials: JD
authors.lastname: Horton
authors.forename: Kent J
authors.initials: KJ
authors.lastname: DeZee
authors.forename: Michel
authors.initials: M
authors.lastname: Wagner
mesh_terms: D002985:Clinical Protocols; D003029:Coagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D004363:Drug Utilization; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D015942:Factor VIIa / Q000008:administration & dosage / Q000627:therapeutic use*; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D013502:General Surgery / Q000193:education / Q000706:statistics & numerical data; D006801:Humans; D016134:Organizational Policy; D010818:Practice Patterns, Physicians'; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D014193:Trauma Centers / Q000145:classification / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000601:surgery
chemical_list: D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa