The impact of platelet transfusion in massively transfused trauma patients

Kenji Inaba, Thomas Lustenberger, Peter M Rhee, John B. Holcomb, Lorne H. Blackbourne, Ira Shulman, Janice Nelson, Peep Talving, Demetrios Demetriades

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Abstract

Background The impact of platelet transfusion in trauma patients undergoing a massive transfusion (MT) was evaluated. Study Design The Institutional Trauma Registry and Blood Bank Database at a Level I trauma center was used to identify all patients requiring an MT (≥10 packed red blood cells [PRBC] within 24 hours of admission). Mortality was evaluated according to 4 apheresis platelet (aPLT):PRBC ratios: Low ratio (<1:18), medium ratio (≥1:18 and <1:12), high ratio (≥1:12 and <1:6), and highest ratio (≥1:6). Results Of 32,289 trauma patients, a total of 657 (2.0%) required an MT. At 24 hours, 171 patients (26.0%) received a low ratio, 77 (11.7%) a medium ratio, 249 (37.9%) a high ratio, and 160 (24.4%) the highest ratio of aPLT:PRBC. After correcting for differences between groups, the mortality at 24 hours increased in a stepwise fashion with decreasing aPLT:PRBC ratio. Using the highest ratio group as a reference, the adjusted relative risk of death was 1.67 (adjusted p = 0.054) for the high ratio group, 2.28 (adjusted p = 0.013) for the medium ratio group, and 5.51 (adjusted p < 0.001) for the low ratio group. A similar stepwise increase in mortality with decreasing platelet ratio was observed at 12 hours after admission and for overall survival to discharge. After stepwise logistic regression, a high aPLT:PRBC ratio (adjusted p < 0.001) was independently associated with improved survival at 24 hours. Conclusions For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warranted.

Original languageEnglish (US)
Pages (from-to)573-579
Number of pages7
JournalJournal of the American College of Surgeons
Volume211
Issue number5
DOIs
StatePublished - Nov 2010

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Platelet Transfusion
Blood Component Removal
Blood Platelets
Erythrocytes
Wounds and Injuries
Survival
Mortality
Blood Banks
Trauma Centers
Registries
Logistic Models
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Inaba, K., Lustenberger, T., Rhee, P. M., Holcomb, J. B., Blackbourne, L. H., Shulman, I., ... Demetriades, D. (2010). The impact of platelet transfusion in massively transfused trauma patients. Journal of the American College of Surgeons, 211(5), 573-579. https://doi.org/10.1016/j.jamcollsurg.2010.06.392

The impact of platelet transfusion in massively transfused trauma patients. / Inaba, Kenji; Lustenberger, Thomas; Rhee, Peter M; Holcomb, John B.; Blackbourne, Lorne H.; Shulman, Ira; Nelson, Janice; Talving, Peep; Demetriades, Demetrios.

In: Journal of the American College of Surgeons, Vol. 211, No. 5, 11.2010, p. 573-579.

Research output: Contribution to journalArticle

Inaba, K, Lustenberger, T, Rhee, PM, Holcomb, JB, Blackbourne, LH, Shulman, I, Nelson, J, Talving, P & Demetriades, D 2010, 'The impact of platelet transfusion in massively transfused trauma patients', Journal of the American College of Surgeons, vol. 211, no. 5, pp. 573-579. https://doi.org/10.1016/j.jamcollsurg.2010.06.392
Inaba, Kenji ; Lustenberger, Thomas ; Rhee, Peter M ; Holcomb, John B. ; Blackbourne, Lorne H. ; Shulman, Ira ; Nelson, Janice ; Talving, Peep ; Demetriades, Demetrios. / The impact of platelet transfusion in massively transfused trauma patients. In: Journal of the American College of Surgeons. 2010 ; Vol. 211, No. 5. pp. 573-579.
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abstract = "Background The impact of platelet transfusion in trauma patients undergoing a massive transfusion (MT) was evaluated. Study Design The Institutional Trauma Registry and Blood Bank Database at a Level I trauma center was used to identify all patients requiring an MT (≥10 packed red blood cells [PRBC] within 24 hours of admission). Mortality was evaluated according to 4 apheresis platelet (aPLT):PRBC ratios: Low ratio (<1:18), medium ratio (≥1:18 and <1:12), high ratio (≥1:12 and <1:6), and highest ratio (≥1:6). Results Of 32,289 trauma patients, a total of 657 (2.0{\%}) required an MT. At 24 hours, 171 patients (26.0{\%}) received a low ratio, 77 (11.7{\%}) a medium ratio, 249 (37.9{\%}) a high ratio, and 160 (24.4{\%}) the highest ratio of aPLT:PRBC. After correcting for differences between groups, the mortality at 24 hours increased in a stepwise fashion with decreasing aPLT:PRBC ratio. Using the highest ratio group as a reference, the adjusted relative risk of death was 1.67 (adjusted p = 0.054) for the high ratio group, 2.28 (adjusted p = 0.013) for the medium ratio group, and 5.51 (adjusted p < 0.001) for the low ratio group. A similar stepwise increase in mortality with decreasing platelet ratio was observed at 12 hours after admission and for overall survival to discharge. After stepwise logistic regression, a high aPLT:PRBC ratio (adjusted p < 0.001) was independently associated with improved survival at 24 hours. Conclusions For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warranted.",
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AB - Background The impact of platelet transfusion in trauma patients undergoing a massive transfusion (MT) was evaluated. Study Design The Institutional Trauma Registry and Blood Bank Database at a Level I trauma center was used to identify all patients requiring an MT (≥10 packed red blood cells [PRBC] within 24 hours of admission). Mortality was evaluated according to 4 apheresis platelet (aPLT):PRBC ratios: Low ratio (<1:18), medium ratio (≥1:18 and <1:12), high ratio (≥1:12 and <1:6), and highest ratio (≥1:6). Results Of 32,289 trauma patients, a total of 657 (2.0%) required an MT. At 24 hours, 171 patients (26.0%) received a low ratio, 77 (11.7%) a medium ratio, 249 (37.9%) a high ratio, and 160 (24.4%) the highest ratio of aPLT:PRBC. After correcting for differences between groups, the mortality at 24 hours increased in a stepwise fashion with decreasing aPLT:PRBC ratio. Using the highest ratio group as a reference, the adjusted relative risk of death was 1.67 (adjusted p = 0.054) for the high ratio group, 2.28 (adjusted p = 0.013) for the medium ratio group, and 5.51 (adjusted p < 0.001) for the low ratio group. A similar stepwise increase in mortality with decreasing platelet ratio was observed at 12 hours after admission and for overall survival to discharge. After stepwise logistic regression, a high aPLT:PRBC ratio (adjusted p < 0.001) was independently associated with improved survival at 24 hours. Conclusions For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warranted.

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