Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes

Joel Elterman, Karen Brasel, Siobhan Brown, Eileen Bulger, Jim Christenson, Jeffrey D. Kerby, Delores Kannas, Steven Lin, Joseph P. Minei, Sandro Rizoli, Samuel Tisherman, Martin A. Schreiber

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76%weremale, and 98%experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p < 0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95%CI, 0.74-0.92; p < 0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p < 0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.

Original languageEnglish (US)
Pages (from-to)8-14
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1
DOIs
StatePublished - Jul 2013

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Erythrocyte Transfusion
Glasgow Coma Scale
Shock
Blood Pressure
Hemoglobins
Survival
Wounds and Injuries
Confidence Intervals
Heart Rate
Odds Ratio
Organ Dysfunction Scores
Glasgow Outcome Scale
Injury Severity Score
Emergency Medical Services
Resuscitation
Randomized Controlled Trials
Erythrocytes

Keywords

  • Resuscitation
  • Transfusion
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes. / Elterman, Joel; Brasel, Karen; Brown, Siobhan; Bulger, Eileen; Christenson, Jim; Kerby, Jeffrey D.; Kannas, Delores; Lin, Steven; Minei, Joseph P.; Rizoli, Sandro; Tisherman, Samuel; Schreiber, Martin A.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1, 07.2013, p. 8-14.

Research output: Contribution to journalArticle

Elterman, J, Brasel, K, Brown, S, Bulger, E, Christenson, J, Kerby, JD, Kannas, D, Lin, S, Minei, JP, Rizoli, S, Tisherman, S & Schreiber, MA 2013, 'Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1, pp. 8-14. https://doi.org/10.1097/TA.0b013e318298492e
Elterman, Joel ; Brasel, Karen ; Brown, Siobhan ; Bulger, Eileen ; Christenson, Jim ; Kerby, Jeffrey D. ; Kannas, Delores ; Lin, Steven ; Minei, Joseph P. ; Rizoli, Sandro ; Tisherman, Samuel ; Schreiber, Martin A. / Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1. pp. 8-14.
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abstract = "BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76{\%}weremale, and 98{\%}experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95{\%} confidence interval [CI], 0.74-0.93; p < 0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95{\%}CI, 0.74-0.92; p < 0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95{\%} CI, 0.19-0.70; p < 0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.",
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T1 - Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes

AU - Elterman, Joel

AU - Brasel, Karen

AU - Brown, Siobhan

AU - Bulger, Eileen

AU - Christenson, Jim

AU - Kerby, Jeffrey D.

AU - Kannas, Delores

AU - Lin, Steven

AU - Minei, Joseph P.

AU - Rizoli, Sandro

AU - Tisherman, Samuel

AU - Schreiber, Martin A.

PY - 2013/7

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N2 - BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76%weremale, and 98%experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p < 0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95%CI, 0.74-0.92; p < 0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p < 0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.

AB - BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76%weremale, and 98%experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p < 0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95%CI, 0.74-0.92; p < 0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p < 0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.

KW - Resuscitation

KW - Transfusion

KW - Traumatic brain injury

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