The impact of uncross-matched blood transfusion on the need for massive transfusion and mortality: Analysis of 5,166 uncross-matched units

Kenji Inaba, Pedro G R Teixeira, Ira Shulman, Janice Nelson, John Lee, A. Salim, Carlos Brown, Demetrios Demetriades, Peter Rhee

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

BACKGROUND:: The objective of this study was to analyze the outcomes associated with uncross-matched blood transfusion during trauma resuscitation. Our hypothesis was that uncross-matched blood transfusion is a predictor of the need for massive transfusion and mortality. METHODS:: All injured patients receiving packed red blood cell (PRBC) transfusion during a 6-year period ending December 2005 were identified from the blood bank database at a level I trauma center. Uncross-matched red blood cell (URBC) and cross-matched red blood cells, plasma and platelet utilization, and injury demographics were abstracted for each patient. RESULTS:: Of 25,599 trauma patients, 4,241 (16.6%) patients received 29,375 units of PRBC and 1,236 (29.1%) of the transfused patients received 5,166 units of URBC during their resuscitation. Patients requiring URBC had a higher mortality (39.6% vs. 11.9%, p < 0.001) and were more likely to require massive (>10 PRBC during 12 hours) transfusion (29.3% vs. 1.8%, p < 0.001). There was a stepwise increase in mortality with increasing URBC transfusion. After adjusting for age, gender, mechanism, hypotension at admission, emergency department intubation, initial hemoglobin, Glasgow Coma Scale, Abbreviated Injury Scale, Injury Severity Score, and amount of blood products received; URBC remained an independent predictor of mortality (adjusted odds ratio 2.15; 95% confidence interval 1.58-2.94; p < 0.001) and massive transfusion (adjusted odds ratio, 11.87; 95% confidence interval, 8.43-16.7; p < 0.001). Patients receiving URBC also utilized more blood components (11.9 ± 12.7 vs. 4.9 ± 5.8 units of PRBC, p < 0.001; 5.1 ± 8.9 vs. 2.0 ± 4.8 units of plasma, p < 0.001; and 1.1 ± 2.5 vs. 0.4 ± 1.6 units of platelets, p < 0.001). CONCLUSION:: The requirement for uncross-matched blood during the acute resuscitation of trauma patients is an independent predictor of mortality and the need for massive transfusion. A URBC request during resuscitation should be considered by the blood bank as a potential trigger to prepare for massive transfusion.

Original languageEnglish (US)
Pages (from-to)1222-1226
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume65
Issue number6
DOIs
StatePublished - Dec 2008

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Blood Transfusion
Erythrocytes
Mortality
Resuscitation
Erythrocyte Transfusion
Blood Banks
Wounds and Injuries
Blood Platelets
Odds Ratio
Abbreviated Injury Scale
Confidence Intervals
Glasgow Coma Scale
Injury Severity Score
Trauma Centers
Intubation
Hypotension
Hospital Emergency Service
Hemoglobins
Demography
Databases

Keywords

  • Blood components
  • Blood transfusion
  • Injury
  • Mortality
  • Outcome
  • Uncross-matched blood
  • Wounds and injuries

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The impact of uncross-matched blood transfusion on the need for massive transfusion and mortality : Analysis of 5,166 uncross-matched units. / Inaba, Kenji; Teixeira, Pedro G R; Shulman, Ira; Nelson, Janice; Lee, John; Salim, A.; Brown, Carlos; Demetriades, Demetrios; Rhee, Peter.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 65, No. 6, 12.2008, p. 1222-1226.

Research output: Contribution to journalArticle

Inaba, Kenji ; Teixeira, Pedro G R ; Shulman, Ira ; Nelson, Janice ; Lee, John ; Salim, A. ; Brown, Carlos ; Demetriades, Demetrios ; Rhee, Peter. / The impact of uncross-matched blood transfusion on the need for massive transfusion and mortality : Analysis of 5,166 uncross-matched units. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 65, No. 6. pp. 1222-1226.
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abstract = "BACKGROUND:: The objective of this study was to analyze the outcomes associated with uncross-matched blood transfusion during trauma resuscitation. Our hypothesis was that uncross-matched blood transfusion is a predictor of the need for massive transfusion and mortality. METHODS:: All injured patients receiving packed red blood cell (PRBC) transfusion during a 6-year period ending December 2005 were identified from the blood bank database at a level I trauma center. Uncross-matched red blood cell (URBC) and cross-matched red blood cells, plasma and platelet utilization, and injury demographics were abstracted for each patient. RESULTS:: Of 25,599 trauma patients, 4,241 (16.6{\%}) patients received 29,375 units of PRBC and 1,236 (29.1{\%}) of the transfused patients received 5,166 units of URBC during their resuscitation. Patients requiring URBC had a higher mortality (39.6{\%} vs. 11.9{\%}, p < 0.001) and were more likely to require massive (>10 PRBC during 12 hours) transfusion (29.3{\%} vs. 1.8{\%}, p < 0.001). There was a stepwise increase in mortality with increasing URBC transfusion. After adjusting for age, gender, mechanism, hypotension at admission, emergency department intubation, initial hemoglobin, Glasgow Coma Scale, Abbreviated Injury Scale, Injury Severity Score, and amount of blood products received; URBC remained an independent predictor of mortality (adjusted odds ratio 2.15; 95{\%} confidence interval 1.58-2.94; p < 0.001) and massive transfusion (adjusted odds ratio, 11.87; 95{\%} confidence interval, 8.43-16.7; p < 0.001). Patients receiving URBC also utilized more blood components (11.9 ± 12.7 vs. 4.9 ± 5.8 units of PRBC, p < 0.001; 5.1 ± 8.9 vs. 2.0 ± 4.8 units of plasma, p < 0.001; and 1.1 ± 2.5 vs. 0.4 ± 1.6 units of platelets, p < 0.001). CONCLUSION:: The requirement for uncross-matched blood during the acute resuscitation of trauma patients is an independent predictor of mortality and the need for massive transfusion. A URBC request during resuscitation should be considered by the blood bank as a potential trigger to prepare for massive transfusion.",
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AU - Teixeira, Pedro G R

AU - Shulman, Ira

AU - Nelson, Janice

AU - Lee, John

AU - Salim, A.

AU - Brown, Carlos

AU - Demetriades, Demetrios

AU - Rhee, Peter

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N2 - BACKGROUND:: The objective of this study was to analyze the outcomes associated with uncross-matched blood transfusion during trauma resuscitation. Our hypothesis was that uncross-matched blood transfusion is a predictor of the need for massive transfusion and mortality. METHODS:: All injured patients receiving packed red blood cell (PRBC) transfusion during a 6-year period ending December 2005 were identified from the blood bank database at a level I trauma center. Uncross-matched red blood cell (URBC) and cross-matched red blood cells, plasma and platelet utilization, and injury demographics were abstracted for each patient. RESULTS:: Of 25,599 trauma patients, 4,241 (16.6%) patients received 29,375 units of PRBC and 1,236 (29.1%) of the transfused patients received 5,166 units of URBC during their resuscitation. Patients requiring URBC had a higher mortality (39.6% vs. 11.9%, p < 0.001) and were more likely to require massive (>10 PRBC during 12 hours) transfusion (29.3% vs. 1.8%, p < 0.001). There was a stepwise increase in mortality with increasing URBC transfusion. After adjusting for age, gender, mechanism, hypotension at admission, emergency department intubation, initial hemoglobin, Glasgow Coma Scale, Abbreviated Injury Scale, Injury Severity Score, and amount of blood products received; URBC remained an independent predictor of mortality (adjusted odds ratio 2.15; 95% confidence interval 1.58-2.94; p < 0.001) and massive transfusion (adjusted odds ratio, 11.87; 95% confidence interval, 8.43-16.7; p < 0.001). Patients receiving URBC also utilized more blood components (11.9 ± 12.7 vs. 4.9 ± 5.8 units of PRBC, p < 0.001; 5.1 ± 8.9 vs. 2.0 ± 4.8 units of plasma, p < 0.001; and 1.1 ± 2.5 vs. 0.4 ± 1.6 units of platelets, p < 0.001). CONCLUSION:: The requirement for uncross-matched blood during the acute resuscitation of trauma patients is an independent predictor of mortality and the need for massive transfusion. A URBC request during resuscitation should be considered by the blood bank as a potential trigger to prepare for massive transfusion.

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KW - Blood components

KW - Blood transfusion

KW - Injury

KW - Mortality

KW - Outcome

KW - Uncross-matched blood

KW - Wounds and injuries

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