Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air Medical Trauma Patients - 22/04/15
, Anisleidy Fombona, BS a, Timothy R. Billiar, MD, FACS a, Andrew B. Peitzman, MD, FACS a, Francis X. Guyette, MD, MPH bAbstract |
Background |
Hemorrhage is the leading cause of survivable death in trauma and resuscitation strategies including early RBC transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients.
Study Design |
We conducted a retrospective cohort study of trauma patients transported by helicopter to a Level I trauma center from 2007 to 2012. Patients receiving PTC RBC transfusion were matched to control patients (receiving no PTC RBC transfusion during transport) in a 1:2 ratio using a propensity score based on prehospital variables. Conditional logistic regression and mixed-effects linear regression were used to determine the association of PTC RBC transfusion with outcomes. Subgroup analysis was performed for scene transport patients.
Results |
Two-hundred and forty treatment patients were matched to 480 control patients receiving no PTC RBC transfusion. Pre-trauma center RBC transfusion was associated with increased odds of 24-hour survival (adjusted odds ratio [AOR] = 4.92; 95% CI, 1.51–16.04; p = 0.01), lower odds of shock (AOR = 0.28; 95% CI, 0.09–0.85; p = 0.03), and lower 24-hour RBC requirement (Coefficient −3.6 RBC units; 95% CI, −7.0 to −0.2; p = 0.04). Among matched scene patients, PTC RBC was also associated with increased odds of 24-hour survival (AOR = 6.31; 95% CI, 1.88–21.14; p < 0.01), lower odds of shock (AOR = 0.24; 95% CI, 0.07–0.80; p = 0.02), and lower 24-hour RBC requirement (Coefficient −4.5 RBC units; 95% CI, −8.3 to −0.7; p = 0.02).
Conclusions |
Pre-trauma center RBC was associated with an increased probability of 24-hour survival, decreased risk of shock, and lower 24-hour RBC requirement. Pre-trauma center RBC appears beneficial in severely injured air medical trauma patients and prospective study is warranted as PTC RBC transfusion becomes more readily available.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : HEMS, HR, INR, ISS, PTC, SBP, TIC, TMPM, UPMC
Plan
| CME questions for this article available at jacscme.facs.org |
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| Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. |
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| Support: Dr Brown receives support from an institutional T32 Ruth L Kischstein National Research Service Award training grant (5T32GM008516-20) from the National Institutes of Health. Dr Sperry receives support from a career development award (K23GM093032) from the National Institute of General Medical Sciences. |
Vol 220 - N° 5
P. 797-808 - mai 2015 Retour au numéro
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