Brown Joshua B, Sperry Jason L, Fombona Anisleidy, Billiar Timothy R, Peitzman Andrew B, Guyette Francis X
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Am Coll Surg. 2015 May;220(5):797-808. doi: 10.1016/j.jamcollsurg.2015.01.006. Epub 2015 Jan 24.
Hemorrhage is the leading cause of survivable death in trauma and resuscitation strategies including early RBC transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients.
We conducted a retrospective cohort study of trauma patients transported by helicopter to a Level I trauma center from 2007 to 2012. Patients receiving PTC RBC transfusion were matched to control patients (receiving no PTC RBC transfusion during transport) in a 1:2 ratio using a propensity score based on prehospital variables. Conditional logistic regression and mixed-effects linear regression were used to determine the association of PTC RBC transfusion with outcomes. Subgroup analysis was performed for scene transport patients.
Two-hundred and forty treatment patients were matched to 480 control patients receiving no PTC RBC transfusion. Pre-trauma center RBC transfusion was associated with increased odds of 24-hour survival (adjusted odds ratio [AOR] = 4.92; 95% CI, 1.51-16.04; p = 0.01), lower odds of shock (AOR = 0.28; 95% CI, 0.09-0.85; p = 0.03), and lower 24-hour RBC requirement (Coefficient -3.6 RBC units; 95% CI, -7.0 to -0.2; p = 0.04). Among matched scene patients, PTC RBC was also associated with increased odds of 24-hour survival (AOR = 6.31; 95% CI, 1.88-21.14; p < 0.01), lower odds of shock (AOR = 0.24; 95% CI, 0.07-0.80; p = 0.02), and lower 24-hour RBC requirement (Coefficient -4.5 RBC units; 95% CI, -8.3 to -0.7; p = 0.02).
Pre-trauma center RBC was associated with an increased probability of 24-hour survival, decreased risk of shock, and lower 24-hour RBC requirement. Pre-trauma center RBC appears beneficial in severely injured air medical trauma patients and prospective study is warranted as PTC RBC transfusion becomes more readily available.
出血是创伤中可避免死亡的主要原因，包括早期红细胞输注在内的复苏策略已降低了这一情况。创伤中心前（PTC）红细胞输注呈增长趋势，初步证据表明其可改善预后。本研究目的是评估PTC红细胞输注与空中医疗创伤患者预后的相关性。
我们对2007年至2012年通过直升机转运至一级创伤中心的创伤患者进行了一项回顾性队列研究。使用基于院前变量的倾向评分，将接受PTC红细胞输注的患者与对照患者（转运期间未接受PTC红细胞输注）按1:2的比例进行匹配。采用条件逻辑回归和混合效应线性回归来确定PTC红细胞输注与预后的相关性。对现场转运患者进行了亚组分析。
240例治疗患者与480例未接受PTC红细胞输注的对照患者进行了匹配。创伤中心前红细胞输注与24小时生存率增加相关（调整后的优势比[AOR]=4.92；95%可信区间[CI]，1.51-16.04；p=0.01），休克几率降低（AOR=0.28；95%CI，0.09-0.85；p=0.03），以及24小时红细胞需求量降低（系数-3.6个红细胞单位；95%CI，-7.0至-0.2；p=0.04）。在匹配的现场患者中，PTC红细胞输注也与24小时生存率增加相关（AOR=6.31；95%CI，1.88-21.14；p<0.01），休克几率降低（AOR=0.24；95%CI，0.07-0.80；p=0.02），以及24小时红细胞需求量降低（系数-4.5个红细胞单位；95%CI，-8.3至-0.7；p=0.02）。
创伤中心前红细胞输注与24小时生存率增加、休克风险降低以及24小时红细胞需求量降低相关。创伤中心前红细胞输注似乎对严重受伤的空中医疗创伤患者有益，随着PTC红细胞输注更容易获得，有必要进行前瞻性研究。
