The panel did not formulate the questions and had no influence on the content presented at the meeting.The Consensus Conference process also has weaknesses. The panel was not asked to conduct a formal systematic review of the literature or to provide a grading of the quality of prior published literature. inhibitor Belinostat The views of the panel therefore represent expert independent opinion.Prevention of trauma is cost-effectiveThere can be little doubt that many injury-prevention measures, already implemented, are more cost-effective than the treatment of trauma; and this fact should weigh heavily on decisions regarding allocation of government funding to promote wider acceptance of prevention programs [51,52].

Despite prevention efforts, injuries related to motor vehicles [53], self-inflicted trauma including suicide [54], and use of alcohol or drugs [53,55] remain common preventable causes of injury. Opportunities thus remain for further reduction of serious injury and death from motor vehicle accidents, falls, and trauma related to firearms, alcohol and drug abuse, and depression.Only a very small percentage of trauma patients can have survival directly affected by changes to current transfusion strategiesThe great majority of trauma victims do not experience massive hemorrhage. Among fatally injured patients 40 to 60% die at the scene or in transit, with higher fatality rates in rural settings [56-59]. A review of trauma fatalities from a Canadian level 1 trauma program found that 15% died from hemorrhage and that 16% of these deaths were deemed preventable [60].

Among the preventable deaths, the root cause was delayed recognition in hospital of bleeding rather than preventable death due to blood transfusion strategies. An additional 11% died from a combination of bleeding and severe central nervous system injury where transfusion practice has less impact on overall survival. Similar estimates were found at another Canadian level 1 trauma center (RS Morad Hameed, personal communication, Vancouver General Hospital, 2011). If 40-60% of trauma fatalities occur prior to admission to hospital, and if 15% of hospitalized trauma cases die from hemorrhage, then even if 20% of hospitalized trauma cases could be saved by alternative strategies of transfusion support, only 1% to 3% of all trauma fatalities could be directly addressed by changes in transfusion practice.

Because some fatal bleeding outcomes result from Anacetrapib extensive and uncorrectable anatomic injury, the percentage of preventable bleeding deaths that can be directly addressed by changes in blood transfusion practice is likely to be even lower.These estimates are relevant to the importance of injury prevention, for considerations of the cost-effectiveness of transfusion strategies, and for determining the required size of prospective clinical trials focused on transfusion.