Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
J Surg Res. 2019 Feb;234:110-115. doi: 10.1016/j.jss.2018.09.018. Epub 2018 Oct 6.
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.
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.
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.
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.
失血性创伤患者常需大量输血（定义为在最初 24 小时内输注 10 个或更多红细胞单位）。我们研究的目的是评估在不同级别创伤中心接受大量输血的创伤患者的结局。
对美国外科医师学会创伤质量改进计划 2 年（2013-2014 年）的回顾性分析。我们纳入了所有接受大量输血（MT）的成年创伤患者。主要观察指标是死亡率、住院时间、重症监护病房无呼吸机天数、呼吸机无天数、输血量和并发症。
我们共分析了 416957 例患者，其中 2776 例符合纳入标准并纳入研究。平均年龄为 40.6±20 岁，78.3%为男性，33.1%的损伤为穿透性。损伤严重程度评分中位数（IQR）为 29[18-40]，格拉斯哥昏迷评分中位数（IQR）为 10[4-15]。24 小时内平均红细胞输注量为 20±13 单位，平均血浆输注量为 13±11 单位。总体院内死亡率为 43.5%。在 I 级创伤中心接受 MT 治疗与死亡率降低独立相关（比值比[OR]：0.75[0.46-0.96]，P<0.001）。较高的损伤严重程度评分（OR：1.020[1.010-1.030]，P<0.001）和输注的红细胞单位数增加（OR：1.067[1.041-1.093]，P<0.001）与死亡率增加独立相关。然而，教学状态、年龄、性别、急诊科生命体征和血浆输注量与死亡率之间无相关性。
出血仍然是创伤后死亡的最常见原因之一。近一半接受大量输血的患者死亡。与 II 级创伤中心相比，在 I 级创伤中心接受大量输血的患者存活率提高。
