Outcomes After Massive Transfusion in Trauma Patients: Variability Among Trauma Centers

Mohammad Hamidi, Muhammad Zeeshan, Narong Kulvatunyou, Eseoghene Adun, Terence S Okeeffe, El Rasheid Zakaria, Lynn Gries, Bellal A Joseph

Research output: Contribution to journalArticle

Abstract

Background: Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 h). The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different levels of trauma centers. Methods: Two-y (2013-2014) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adult trauma patients who received massive transfusion (MT) of blood. Outcome measures were mortality, hospital length of stay, intensive care unit–free and ventilator-free days, blood products received, and complications. Results: We analyzed a total of 416,957 patients, of which 2776 met the inclusion criteria and included in the study. Mean age was 40.6 ± 20 y, 78.3% were males and 33.1% of the injuries were penetrating. Median injury severity score [IQR] was 29 [18-40], median [IQR] Glasgow Coma Scale 10[4-15]. Mean packed red blood cells transfusion in the first 24 h was 20 ± 13 units and mean plasma transfusion was 13 ± 11 units. Overall in-hospital mortality was 43.5%. Receiving MT in level I trauma center was independently associated with lower rates of mortality (odds ratio [OR]: 0.75 [0.46-0.96], P < 0.001). Higher injury severity score (OR: 1.020 [1.010-1.030], P < 0.001) and increased units of packed red blood cells transfused (OR: 1.067 [1.041-1.093], P < 0.001) were independently associated with increased mortality. However, there was no association between teaching status, age, gender, emergency department vitals, and units of plasma transfused. Conclusions: Hemorrhage continues to remain one of the most common cause of death after trauma. Almost half of the patients who received massive transfusion died. Patients who receive massive blood transfusion in a level I trauma centers have improved survival compared with level II trauma centers.

LanguageEnglish (US)
Pages110-115
Number of pages6
JournalJournal of Surgical Research
Volume234
DOIs
StatePublished - Feb 1 2019

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Trauma Centers
Wounds and Injuries
Blood Transfusion
Injury Severity Score
Odds Ratio
Mortality
Hospital Emergency Service
Length of Stay
Erythrocyte Transfusion
Glasgow Coma Scale
Mechanical Ventilators
Quality Improvement
Hospital Mortality
Intensive Care Units
Cause of Death
Teaching
Erythrocytes
Outcome Assessment (Health Care)
Hemorrhage
Survival

ASJC Scopus subject areas

  • Surgery

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Outcomes After Massive Transfusion in Trauma Patients : Variability Among Trauma Centers. / Hamidi, Mohammad; Zeeshan, Muhammad; Kulvatunyou, Narong; Adun, Eseoghene; Okeeffe, Terence S; Zakaria, El Rasheid; Gries, Lynn; Joseph, Bellal A.

In: Journal of Surgical Research, Vol. 234, 01.02.2019, p. 110-115.

Research output: Contribution to journalArticle

Hamidi, Mohammad ; Zeeshan, Muhammad ; Kulvatunyou, Narong ; Adun, Eseoghene ; Okeeffe, Terence S ; Zakaria, El Rasheid ; Gries, Lynn ; Joseph, Bellal A. / Outcomes After Massive Transfusion in Trauma Patients : Variability Among Trauma Centers. In: Journal of Surgical Research. 2019 ; Vol. 234. pp. 110-115.
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abstract = "Background: Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 h). The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different levels of trauma centers. Methods: Two-y (2013-2014) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adult trauma patients who received massive transfusion (MT) of blood. Outcome measures were mortality, hospital length of stay, intensive care unit–free and ventilator-free days, blood products received, and complications. Results: We analyzed a total of 416,957 patients, of which 2776 met the inclusion criteria and included in the study. Mean age was 40.6 ± 20 y, 78.3{\%} were males and 33.1{\%} of the injuries were penetrating. Median injury severity score [IQR] was 29 [18-40], median [IQR] Glasgow Coma Scale 10[4-15]. Mean packed red blood cells transfusion in the first 24 h was 20 ± 13 units and mean plasma transfusion was 13 ± 11 units. Overall in-hospital mortality was 43.5{\%}. Receiving MT in level I trauma center was independently associated with lower rates of mortality (odds ratio [OR]: 0.75 [0.46-0.96], P < 0.001). Higher injury severity score (OR: 1.020 [1.010-1.030], P < 0.001) and increased units of packed red blood cells transfused (OR: 1.067 [1.041-1.093], P < 0.001) were independently associated with increased mortality. However, there was no association between teaching status, age, gender, emergency department vitals, and units of plasma transfused. Conclusions: Hemorrhage continues to remain one of the most common cause of death after trauma. Almost half of the patients who received massive transfusion died. Patients who receive massive blood transfusion in a level I trauma centers have improved survival compared with level II trauma centers.",
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AU - Hamidi, Mohammad

AU - Zeeshan, Muhammad

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AU - Adun, Eseoghene

AU - Okeeffe, Terence S

AU - Zakaria, El Rasheid

AU - Gries, Lynn

AU - Joseph, Bellal A

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AB - Background: Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 h). The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different levels of trauma centers. Methods: Two-y (2013-2014) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adult trauma patients who received massive transfusion (MT) of blood. Outcome measures were mortality, hospital length of stay, intensive care unit–free and ventilator-free days, blood products received, and complications. Results: We analyzed a total of 416,957 patients, of which 2776 met the inclusion criteria and included in the study. Mean age was 40.6 ± 20 y, 78.3% were males and 33.1% of the injuries were penetrating. Median injury severity score [IQR] was 29 [18-40], median [IQR] Glasgow Coma Scale 10[4-15]. Mean packed red blood cells transfusion in the first 24 h was 20 ± 13 units and mean plasma transfusion was 13 ± 11 units. Overall in-hospital mortality was 43.5%. Receiving MT in level I trauma center was independently associated with lower rates of mortality (odds ratio [OR]: 0.75 [0.46-0.96], P < 0.001). Higher injury severity score (OR: 1.020 [1.010-1.030], P < 0.001) and increased units of packed red blood cells transfused (OR: 1.067 [1.041-1.093], P < 0.001) were independently associated with increased mortality. However, there was no association between teaching status, age, gender, emergency department vitals, and units of plasma transfused. Conclusions: Hemorrhage continues to remain one of the most common cause of death after trauma. Almost half of the patients who received massive transfusion died. Patients who receive massive blood transfusion in a level I trauma centers have improved survival compared with level II trauma centers.

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