Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level i trauma center

Christopher J. Dente, Beth H. Shaz, Jeffery M. Nicholas, Robert S. Harris, Amy D. Wyrzykowski, Brooks W. Ficke, Gary - Vercruysse, David V. Feliciano, Grace S. Rozycki, Jeffrey P. Salomone, Walter L. Ingram

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Early prediction of the need for massive transfusion (MT) remains difficult. We hypothesized that MT protocol (MTP) utilization would improve by identifying markers for MT (>10 units packed red blood cell [PRBC] in 24 hours) in torso gunshot wounds (GSW) requiring early transfusion and operation. Methods: Data from all MTPs were collected prospectively from February 1, 2007, to January 31, 2009. Demographic, transfusion, anatomic, and operative data were analyzed for MT predictors. Results: Of the 216 MTP activations, 78 (36%) patients sustained torso GSW requiring early transfusion and operation. Five were moribund and died before receiving MT. Of 73 early survivors, 56 received MT (76%, mean 19 units PRBC) and 17 had early bleeding control (EBC), (24%, mean 5 units PRBC). Twelve transpelvic and 13 multicavitary wounds all received MT regardless of initial hemodynamic status (mean systolic blood pressure: 96 mm Hg; range, 50-169). Of 31 MT patients with low-risk trajectories (LRT), 18 (58%) had a systolic blood pressure <90 mm Hg compared with 3 of 17 (17%) in the EBC group (p < 0.01). In these same groups, a base deficit of <-10 was present in 27 of 31 (92%) MT patients versus 4 of 17 (23%) EBC patients (p < 0.01). The presence of both markers identified 97% of patients with LRT who requiring MT and their absence would have potentially eliminated 16 of 17 EBC patients from MTP activation. Conclusions: In patients requiring early operation and transfusion after torso GSW: (1) early initiation of MTP is reasonable for transpelvic and multicavitary trajectories regardless of initial hemodynamic status as multiple or difficult to control bleeding sources are likely and (2) early initiation of MTP in patients with LRT may be guided by a combination of hypotension and acidosis, indicating massive blood loss.

Original languageEnglish (US)
Pages (from-to)298-304
Number of pages7
JournalJournal of Trauma
Volume68
Issue number2
DOIs
StatePublished - Feb 2010
Externally publishedYes

Fingerprint

Torso
Gunshot Wounds
Trauma Centers
Hemorrhage
Blood Pressure
Erythrocytes
Hemodynamics
Acidosis
Hypotension
Survivors
Demography
Control Groups
MT protocol
Wounds and Injuries

Keywords

  • Early markers
  • Exsanguination
  • Massive transfusion
  • Protocol

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Dente, C. J., Shaz, B. H., Nicholas, J. M., Harris, R. S., Wyrzykowski, A. D., Ficke, B. W., ... Ingram, W. L. (2010). Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level i trauma center. Journal of Trauma, 68(2), 298-304. https://doi.org/10.1097/TA.0b013e3181cf7f2a

Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level i trauma center. / Dente, Christopher J.; Shaz, Beth H.; Nicholas, Jeffery M.; Harris, Robert S.; Wyrzykowski, Amy D.; Ficke, Brooks W.; Vercruysse, Gary -; Feliciano, David V.; Rozycki, Grace S.; Salomone, Jeffrey P.; Ingram, Walter L.

In: Journal of Trauma, Vol. 68, No. 2, 02.2010, p. 298-304.

Research output: Contribution to journalArticle

Dente, CJ, Shaz, BH, Nicholas, JM, Harris, RS, Wyrzykowski, AD, Ficke, BW, Vercruysse, G, Feliciano, DV, Rozycki, GS, Salomone, JP & Ingram, WL 2010, 'Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level i trauma center', Journal of Trauma, vol. 68, no. 2, pp. 298-304. https://doi.org/10.1097/TA.0b013e3181cf7f2a
Dente, Christopher J. ; Shaz, Beth H. ; Nicholas, Jeffery M. ; Harris, Robert S. ; Wyrzykowski, Amy D. ; Ficke, Brooks W. ; Vercruysse, Gary - ; Feliciano, David V. ; Rozycki, Grace S. ; Salomone, Jeffrey P. ; Ingram, Walter L. / Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level i trauma center. In: Journal of Trauma. 2010 ; Vol. 68, No. 2. pp. 298-304.
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abstract = "Background: Early prediction of the need for massive transfusion (MT) remains difficult. We hypothesized that MT protocol (MTP) utilization would improve by identifying markers for MT (>10 units packed red blood cell [PRBC] in 24 hours) in torso gunshot wounds (GSW) requiring early transfusion and operation. Methods: Data from all MTPs were collected prospectively from February 1, 2007, to January 31, 2009. Demographic, transfusion, anatomic, and operative data were analyzed for MT predictors. Results: Of the 216 MTP activations, 78 (36{\%}) patients sustained torso GSW requiring early transfusion and operation. Five were moribund and died before receiving MT. Of 73 early survivors, 56 received MT (76{\%}, mean 19 units PRBC) and 17 had early bleeding control (EBC), (24{\%}, mean 5 units PRBC). Twelve transpelvic and 13 multicavitary wounds all received MT regardless of initial hemodynamic status (mean systolic blood pressure: 96 mm Hg; range, 50-169). Of 31 MT patients with low-risk trajectories (LRT), 18 (58{\%}) had a systolic blood pressure <90 mm Hg compared with 3 of 17 (17{\%}) in the EBC group (p < 0.01). In these same groups, a base deficit of <-10 was present in 27 of 31 (92{\%}) MT patients versus 4 of 17 (23{\%}) EBC patients (p < 0.01). The presence of both markers identified 97{\%} of patients with LRT who requiring MT and their absence would have potentially eliminated 16 of 17 EBC patients from MTP activation. Conclusions: In patients requiring early operation and transfusion after torso GSW: (1) early initiation of MTP is reasonable for transpelvic and multicavitary trajectories regardless of initial hemodynamic status as multiple or difficult to control bleeding sources are likely and (2) early initiation of MTP in patients with LRT may be guided by a combination of hypotension and acidosis, indicating massive blood loss.",
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AU - Ficke, Brooks W.

AU - Vercruysse, Gary -

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