Eng Nina L, Shen Chan, Pradhan Sandeep, Hazelton Joshua P, Martin Matthew J, Nguyen Uyen, Armen Scott B, Oh John S
From the Department of Surgery (N.L.E.), Division of Outcomes Research and Quality (C.S.), and Department of Public Health Sciences (S.P.), Penn State College of Medicine, Hershey; Division of Trauma and Critical Care Surgery (J.P.H.), WellSpan York Hospital, York, Pennsylvania; Division of Trauma Surgery, Department of Surgery (M.J.M.), Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Surgery (U.N.), Heersink School of Medicine at the University of Alabama, Birmingham, Alabama; Division of Trauma Surgery, Department of Surgery (S.B.A.), and Division of Trauma, Acute Care, and Critical Care Surgery, Department of Surgery (J.S.O.), Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.
J Trauma Acute Care Surg. 2025 Aug 1;99(3S Suppl 1):S39-S44. doi: 10.1097/TA.0000000000004730. Epub 2025 Jun 30.
Traumatic brain injury (TBI) is a leading cause of trauma mortality worldwide. Whole blood (WB) is associated with decreased mortality compared with blood component therapy (BCT) alone in trauma patients with hemorrhagic shock (HS). The ideal resuscitation approach in patients with both TBI and HS remains unclear. We hypothesize that resuscitation with WB in trauma patients with TBI and HS improves mortality.
Using a prospective, multicenter, observational database, we examined a subset of patients with TBI and HS. We compared patients receiving BCT only for resuscitation with those receiving WB with BCT. We used χ 2 and Kruskal-Wallis tests to compare categorical and continuous variables by the use of WB. We conducted a multivariable logistic regression to examine the association between WB and mortality controlling for shock index, Injury Severity Score, age, sex, comorbid conditions, serious head injury, and mechanism of injury.
A total of 535 patients were included. One hundred thirty-five patients received BCT, and 400 patients received WB with BCT. There were no differences in the median Injury Severity Score, age, presence of comorbid conditions, proportion of serious head injury, or total component transfusions in the first 24 hours of admission ( p > 0.05). More patients in the WB group were male, in shock, and experienced blunt trauma ( p < 0.05). On multivariable logistic regression, WB use was not independently associated with lower mortality (odds ratio, 1.06; [95% confidence interval, 0.65-1.75]; p=0.809).
We identified no in-hospital mortality benefit of WB transfusion in addition to BCT in trauma patients with TBI and HS. Further research is needed into optimal resuscitation strategies for these patients.
Therapeutic/Care Management; Level III.
创伤性脑损伤（TBI）是全球创伤死亡的主要原因。在出血性休克（HS）的创伤患者中，与单纯血液成分治疗（BCT）相比，全血（WB）与死亡率降低相关。TBI和HS患者的理想复苏方法仍不清楚。我们假设，TBI和HS创伤患者采用WB复苏可提高生存率。
利用前瞻性、多中心观察数据库，我们研究了TBI和HS患者的一个子集。我们将仅接受BCT复苏的患者与接受WB加BCT的患者进行了比较。我们使用χ2检验和Kruskal-Wallis检验，通过WB的使用来比较分类变量和连续变量。我们进行了多变量逻辑回归分析，以检验WB与控制休克指数、损伤严重程度评分、年龄、性别、合并症、严重头部损伤和损伤机制的死亡率之间的关联。
共纳入535例患者。135例患者接受BCT，400例患者接受WB加BCT。入院后24小时内，两组患者的损伤严重程度评分中位数、年龄、合并症的存在情况、严重头部损伤的比例或总成分输血情况均无差异（p>0.05）。WB组男性患者更多，处于休克状态，且经历钝性创伤（p<0.05）。在多变量逻辑回归分析中，使用WB与较低死亡率无独立关联（比值比，1.06；[95%置信区间，0.65-1.75]；p=0.809）。
我们发现，对于TBI和HS的创伤患者，除BCT外，WB输血在院内死亡率方面并无益处。需要对这些患者的最佳复苏策略进行进一步研究。
治疗/护理管理；三级。
