Warren Alpert Medical School, Brown University, Providence, RI, USA.
Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA.
Injury. 2020 Jul;51(7):1468-1476. doi: 10.1016/j.injury.2020.05.007. Epub 2020 May 7.
Worldwide, injuries account for approximately five million mortalities annually, with 90% occurring in low- and middle-income countries (LMICs). Although guidelines characterizing data for blood product transfusion in injury resuscitation have been established for high-income countries (HICs), no such information on use of blood products in LMICs exists. This systematic review evaluated the available literature on the use and associated outcomes of blood product transfusion therapies in LMICs for acute care of patients with injuries.
A systematic search of PubMed, EMBASE, Global Health, CINAHL and Cochrane databases through November 2018 was performed by a health sciences medical librarian. Prospective and cross-sectional reports of injured patients from LMICs involving data on blood product transfusion therapies were included. Two reviewers identified eligible records (κ=0.92); quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Report elements, patient characteristics, injury information, blood transfusion therapies provided and mortality outcomes were extracted and analyzed.
Of 3411 records, 150 full-text reports were reviewed and 17 met inclusion criteria. Identified reports came from the World Health Organization regions of Africa, the Eastern Mediterranean, and South-East Asia. A total of 6535 patients were studied, with the majority from exclusively inpatient hospital settings (52.9%). Data on transfusion therapies demonstrated that packed red blood cells were given to 27.0% of patients, fresh frozen plasma to 13.8%, and unspecified product types to 50.1%. Among patients with blunt and penetrating injuries, 5.8% and 15.7% were treated with blood product transfusions, respectively. Four reports provided data on comparative mortality outcomes, of which two found higher mortality in blood transfusion-treated patients than in untreated patients at 17.4% and 30.4%. The overall quality of evidence was either low (52.9%) or very low (41.2%), with one report of moderate quality by GRADE criteria.
There is a paucity of high-quality data to inform appropriate use of blood transfusion therapies in LMIC injury care. Studies were geographically limited and did not include sufficient data on types of therapies and specific injury patterns treated. Future research in more diverse LMIC settings with improved data collection methods is needed to inform injury care globally.
全球每年约有 500 万人因伤死亡，其中 90%发生在中低收入国家（LMICs）。虽然已经为高收入国家（HICs）制定了用于创伤复苏的血液制品输注数据特征的指南，但在 LMICs 中，关于血液制品使用的信息并不存在。本系统评价评估了现有文献中关于 LMICs 中急性创伤患者血液制品输注治疗的使用和相关结局。
一位健康科学医学图书管理员对 PubMed、EMBASE、全球卫生、CINAHL 和 Cochrane 数据库进行了系统检索，检索时间截至 2018 年 11 月。纳入来自 LMICs 的创伤患者的前瞻性和横断面报告，其中包含血液制品输注治疗的数据。两位审核员确定合格记录（κ=0.92）；使用推荐评估、制定与评价（GRADE）标准评估质量。提取并分析报告要素、患者特征、损伤信息、提供的输血治疗和死亡率结局。
在 3411 条记录中，有 150 篇全文报告进行了审查，其中 17 篇符合纳入标准。确定的报告来自世界卫生组织非洲、东地中海和东南亚区域。共研究了 6535 名患者，其中大多数来自仅限住院医院环境（52.9%）。关于输血治疗的数据表明，有 27.0%的患者给予了浓缩红细胞，13.8%的患者给予了新鲜冰冻血浆，50.1%的患者给予了未特指的产品类型。在钝器伤和穿透伤患者中，分别有 5.8%和 15.7%接受了血液制品输血治疗。有 4 篇报告提供了比较死亡率结局的数据，其中 2 篇报告显示输血治疗组患者的死亡率高于未治疗组，分别为 17.4%和 30.4%。证据的总体质量要么很低（52.9%），要么非常低（41.2%），只有一篇报告按照 GRADE 标准为中等质量。
关于在 LMIC 创伤护理中合理使用血液制品输血治疗的高质量数据非常匮乏。研究在地域上受到限制，且未包括关于治疗的治疗类型和具体损伤模式的足够数据。需要在更多具有不同特点的 LMIC 环境中开展改进数据收集方法的未来研究，以实现全球创伤护理。
