Miller Benjamin T, Du Liping, Krzyzaniak Michael J, Gunter Oliver L, Nunez Timothy C
From the Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
J Trauma Acute Care Surg. 2016 Jul;81(1):15-20. doi: 10.1097/TA.0000000000001045.
The use of prehospital blood transfusion (PBT) in air medical transport has become more widespread. However, the effect of PBT remains unknown. The aim of this study was to examine the impact of PBT on 24-hour and overall in-hospital mortality.
This is a retrospective cohort study of all trauma patients carried by air medical transport from the scene to a Level I trauma center from 2007 to 2013. We excluded patients who died on the helipad or in the emergency department. Primary outcomes measured were 24-hour and overall in-hospital mortality. Multivariable logistic regressions using all available patient data or the propensity score (for receiving PBT)-matched patient data were performed to study the effect of PBT on these outcomes.
Of the 5,581 patients included in the study, 231 (4%) received PBT. Multivariable regression analyses did not show evidence of PBT effect on 24-hour in-hospital mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.61-2.44) and on overall in-hospital mortality (OR, 1.20; 95% CI, 0.55-1.79). In addition, using 1:1 propensity score-matched data, the analysis did not show evidence of PBT effect on 24-hour in-hospital mortality (OR, 1.04; 95% CI, 0.54-1.98) and on overall in-hospital mortality (OR, 1.05; 95% CI, 0.56-1.96). Factors associated with increased 24-hour mortality were advanced age, penetrating injury, increased blood transfusion requirement in the first 24 hours, and decreased Glasgow Coma Scale (GCS) score (p < 0.05). These factors were also associated with overall mortality, in addition to increased Injury Severity Score (ISS) (p < 0.05).
This is the largest study to date of trauma patients who received PBT and were transported from the scene by air medical transport. Our results show no effect of PBT on 24-hour and overall in-hospital mortality. Previous studies also suggest no benefit of PBT, which is counterintuitive to damage-control resuscitation. Prospective data on PBT are needed to assess risk, cost, and benefit.
Therapeutic study, level III.
院前输血（PBT）在航空医疗转运中的应用越来越广泛。然而，PBT的效果仍不明确。本研究的目的是探讨PBT对24小时及院内总死亡率的影响。
这是一项回顾性队列研究，研究对象为2007年至2013年通过航空医疗转运从现场转运至一级创伤中心的所有创伤患者。我们排除了在直升机停机坪或急诊科死亡的患者。主要观察指标为24小时及院内总死亡率。使用所有可用的患者数据或倾向评分（接受PBT）匹配的患者数据进行多变量逻辑回归分析，以研究PBT对这些结局的影响。
在纳入研究的5581例患者中，231例（4%）接受了PBT。多变量回归分析未显示PBT对24小时院内死亡率（优势比[OR]，1.22；95%置信区间[CI]，0.61 - 2.44）和院内总死亡率（OR，1.20；95% CI，0.55 - 1.79）有影响。此外，使用1:1倾向评分匹配数据进行分析，也未显示PBT对24小时院内死亡率（OR，1.04；95% CI，0.54 - 1.98）和院内总死亡率（OR，1.05；95% CI，0.56 - 1.96）有影响。与24小时死亡率增加相关的因素包括高龄、穿透伤、最初24小时内输血需求增加以及格拉斯哥昏迷量表（GCS）评分降低（p < 0.05）。除损伤严重程度评分（ISS）增加外（p < 0.05），这些因素也与总死亡率相关。
这是迄今为止关于接受PBT并通过航空医疗转运从现场转运的创伤患者的最大规模研究。我们的结果显示PBT对24小时及院内总死亡率没有影响。先前的研究也表明PBT没有益处，这与损伤控制复苏的直觉相反。需要关于PBT的前瞻性数据来评估风险、成本和益处。
治疗性研究，III级。
