Pretrauma Center Red Blood Cell Transfusion Is Associated with Reduced Mortality and Coagulopathy in Severely Injured Patients with Blunt Trauma

Joshua B. Brown, Mitchell J. Cohen, Joseph P. Minei, Ronald V. Maier, Michaela A. West, Timothy R. Billiar, Andrew B. Peitzman, Ernest E. Moore, Joseph Cuschieri, Jason L. Sperry

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objective: To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background: Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods: Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results: Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01-0.48; P <0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15-0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01-0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03-0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01-0.95; P = 0.05). Conclusions: PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

Original languageEnglish (US)
Pages (from-to)997-1005
Number of pages9
JournalAnnals of Surgery
Volume261
Issue number5
DOIs
StatePublished - May 1 2015

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Erythrocyte Transfusion
Mortality
Wounds and Injuries
Confidence Intervals
Odds Ratio
Erythrocytes
Risk Reduction Behavior
Blood Group Antigens
Propensity Score
Injury Severity Score
International Normalized Ratio
Trauma Centers
Adhesives
Shock
Logistic Models
Demography
Databases
Prospective Studies
Hemorrhage

Keywords

  • blood
  • prehospital
  • resuscitation
  • transfusion
  • trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Pretrauma Center Red Blood Cell Transfusion Is Associated with Reduced Mortality and Coagulopathy in Severely Injured Patients with Blunt Trauma. / Brown, Joshua B.; Cohen, Mitchell J.; Minei, Joseph P.; Maier, Ronald V.; West, Michaela A.; Billiar, Timothy R.; Peitzman, Andrew B.; Moore, Ernest E.; Cuschieri, Joseph; Sperry, Jason L.

In: Annals of Surgery, Vol. 261, No. 5, 01.05.2015, p. 997-1005.

Research output: Contribution to journalArticle

Brown, JB, Cohen, MJ, Minei, JP, Maier, RV, West, MA, Billiar, TR, Peitzman, AB, Moore, EE, Cuschieri, J & Sperry, JL 2015, 'Pretrauma Center Red Blood Cell Transfusion Is Associated with Reduced Mortality and Coagulopathy in Severely Injured Patients with Blunt Trauma', Annals of Surgery, vol. 261, no. 5, pp. 997-1005. https://doi.org/10.1097/SLA.0000000000000674
Brown, Joshua B. ; Cohen, Mitchell J. ; Minei, Joseph P. ; Maier, Ronald V. ; West, Michaela A. ; Billiar, Timothy R. ; Peitzman, Andrew B. ; Moore, Ernest E. ; Cuschieri, Joseph ; Sperry, Jason L. / Pretrauma Center Red Blood Cell Transfusion Is Associated with Reduced Mortality and Coagulopathy in Severely Injured Patients with Blunt Trauma. In: Annals of Surgery. 2015 ; Vol. 261, No. 5. pp. 997-1005.
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abstract = "Objective: To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background: Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods: Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results: Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52{\%} were scene transports. PTC RBC transfusion was associated with a 95{\%} reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95{\%} confidence interval (CI), 0.01-0.48; P <0.01], 64{\%} reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95{\%} CI, 0.15-0.83; P = 0.02], and 88{\%} reduction in odds of TIC (OR = 0.12; 95{\%} CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31{\%} PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98{\%} reduction in odds of 24-hour mortality (OR = 0.02; 95{\%} CI, 0.01-0.69; P = 0.04), 88{\%} reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95{\%} CI, 0.03-0.61; P = 0.01), and 99{\%} reduction in odds of TIC (OR = 0.01; 95{\%} CI, 0.01-0.95; P = 0.05). Conclusions: PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.",
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AU - Brown, Joshua B.

AU - Cohen, Mitchell J.

AU - Minei, Joseph P.

AU - Maier, Ronald V.

AU - West, Michaela A.

AU - Billiar, Timothy R.

AU - Peitzman, Andrew B.

AU - Moore, Ernest E.

AU - Cuschieri, Joseph

AU - Sperry, Jason L.

PY - 2015/5/1

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N2 - Objective: To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background: Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods: Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results: Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01-0.48; P <0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15-0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01-0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03-0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01-0.95; P = 0.05). Conclusions: PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

AB - Objective: To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background: Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods: Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results: Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01-0.48; P <0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15-0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01-0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03-0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01-0.95; P = 0.05). Conclusions: PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

KW - blood

KW - prehospital

KW - resuscitation

KW - transfusion

KW - trauma

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