Document Detail


The association of blood component use ratios with the survival of massively transfused trauma patients with and without severe brain injury.
MedLine Citation:
PMID:  21814102     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The effect of blood component ratios on the survival of patients with traumatic brain injury (TBI) has not been studied.
METHODS: A database of patients transfused in the first 24 hours after admission for injury from 22 Level I trauma centers over an 18-month period was queried to find patients who (1) met different definitions of massive transfusion (5 units red blood cell [RBC] in 6 hours vs. 10 units RBC in 24 hours), (2) received high or low ratios of platelets or plasma to RBC units (<1:2 vs. ≥ 1:2), and (3) had severe TBI (head abbreviated injury score ≥ 3) (TBI+).
RESULTS: Of 2,312 total patients, 850 patients were transfused with ≥ 5 RBC units in 6 hours and 807 could be classified into TBI+ (n = 281) or TBI- (n = 526). Six hundred forty-three patients were transfused with ≥ 10 RBC units in 24 hours with 622 classified into TBI+ (n = 220) and TBI- (n = 402). For both high-risk populations, a high ratio of platelets:RBCs (not plasma) was independently associated with improved 30-day survival for patients with TBI+ and a high ratio of plasma:RBCs (not platelets) was independently associated with improved 30-day survival in TBI- patients.
CONCLUSIONS: High platelet ratio was associated with improved survival in TBI+ patients while a high plasma ratio was associated with improved survival in TBI- patients. Prospective studies of blood product ratios should include TBI in the analysis for determination of optimal use of ratios on outcome in injured patients.
Authors:
K J Brasel; G Vercruysse; Philip C Spinella; Charles E Wade; Lorne H Blackbourne; Matthew A Borgman; Lee A Zarzabal; Fei Du; Jeremy G Perkins; Marc Maegele; Martin Schreiber; John R Hess; Kenneth M Jastrow; Ernest A Gonzalez; John B Holcomb; Rosemary Kozar; ; K J Brasel; G Vercruysse; J MacLeod; R P Dutton; J C Duchesne; N E McSwain; P Muskat; J Johannigamn; H M Cryer; H M Cryer; J F Pittet; P Knudson; M A De Moya; B Tieu; S Brundage; L M Napolitano; M Brunsvold; K C Sihler; G Beilman; A B Peitzman; M S Zenait; J Sperry; L Alarcon; M A Croce; J P Minei; R M Stewart; S M Cohn; J E Mickalek; E M Bulger; B A Cotton; T C Nunez; R Ivatury; J W Meredith; P Miller; G J Pomper; B Marin
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The Journal of trauma     Volume:  71     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-04     Completed Date:  2011-10-24     Revised Date:  2012-03-27    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S343-52     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri 63110, USA. spinella_p@wustl.kids.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Component Transfusion*
Brain Injuries / blood,  mortality*,  therapy*
Erythrocyte Count
Female
Humans
Male
Middle Aged
Platelet Count
Retrospective Studies
Survival Rate
Trauma Centers
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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