Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society
Background and Objectives About 15% of polytrauma patients receive massive blood transfusion (MBT) defined as ≥ 10 units of packed red blood cells (PRBC). In general, the prognosis of trauma patients receiving MBT is considered to be poor. The purpose of this study was to investigate the impact of...
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| Veröffentlicht in: | Vox sanguinis 2007-01, Vol.92 (1), p.69-78 |
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| creator | Huber-Wagner, S. Qvick, M. Mussack, T. Euler, E. Kay, M. V. Mutschler, W. Kanz, K.-G. |
| description | Background and Objectives About 15% of polytrauma patients receive massive blood transfusion (MBT) defined as ≥ 10 units of packed red blood cells (PRBC). In general, the prognosis of trauma patients receiving MBT is considered to be poor. The purpose of this study was to investigate the impact of MBT on the outcome of polytrauma patients.
Materials and Methods Records of 10 997 patients in the Trauma Registry of the German Trauma Society were analysed. Transfusion data were available from 8182 severe trauma patients with a mean injury severity score of 24·5 and, of these 8182 patients, 1062 received 10 units of PRBC. First, a logistic regression model for the predictors of mortality was performed. Second, incidences of organ failure and sepsis as well as survival rates were analysed.
Results The highest risk for mortality was age over 55 years (odds ratios [OR] 4·7; confidence intervals [CI 95%], 3·5–6·5) followed by Glasgow Coma Scale 8 (OR 4·6; 3·4–6·1), MBT 20 units of PRBC (OR 3·3; 2·1–5·4), thromboplastin time |
| doi_str_mv | 10.1111/j.1423-0410.2006.00858.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68390463</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>68390463</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4358-df683b3153f501d9def1b02e3b7d9153bfc073c7e734613990ee332ae18fbd4e3</originalsourceid><addsrcrecordid>eNqNUU1v1DAQtRCILoW_gHzilsWO49hGXFBFt6BCVSgfN8uJx5AliZfYaTf_gp-M0yzlCL549Oa9N6N5CGFK1jS959s1LXKWkSIBOSHlmhDJ5Xp_D63uGvfRipAizxQh4gg9CmFLEiuX_CE6ooJKyhVboV_vTAjNNeCq9d7iOJg-uDE0vsemt9iPsfYd4KZPs8sc73w7Jc7YGbwzsYE-hhc41YMPO6jjbBTiaCdcmQBJ3uP4HfDVovgA35oQhwl7dwtvYOhM_6f70dcNxOkxeuBMG-DJ4T9Gn05fX52cZecXmzcnr86zumBcZtaVklWMcuY4oVZZcLQiObBKWJXQytVEsFqAYEVJmVIEgLHcAJWusgWwY_Rs8U27_xwhRN01oYa2NT34Mehkr0hRsn8SqeJCqlIkolyIdbpGGMDp3dB0Zpg0JXqOTW_1nI6e09FzbPo2Nr1P0qeHGWPVgf0rPOSUCC8Xwk3TwvTfxvrzxddUJHm2yNP9YX8nN8MPnRYXXH95v9GXp2eXpHjLtWK_AdaJtqc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>19578967</pqid></control><display><type>article</type><title>Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Huber-Wagner, S. ; Qvick, M. ; Mussack, T. ; Euler, E. ; Kay, M. V. ; Mutschler, W. ; Kanz, K.-G.</creator><creatorcontrib>Huber-Wagner, S. ; Qvick, M. ; Mussack, T. ; Euler, E. ; Kay, M. V. ; Mutschler, W. ; Kanz, K.-G. ; Working Group on Polytrauma of German Trauma Society (DGU) ; Working Group on Polytrauma of the German Trauma Society (DGU)</creatorcontrib><description>Background and Objectives About 15% of polytrauma patients receive massive blood transfusion (MBT) defined as ≥ 10 units of packed red blood cells (PRBC). In general, the prognosis of trauma patients receiving MBT is considered to be poor. The purpose of this study was to investigate the impact of MBT on the outcome of polytrauma patients.
Materials and Methods Records of 10 997 patients in the Trauma Registry of the German Trauma Society were analysed. Transfusion data were available from 8182 severe trauma patients with a mean injury severity score of 24·5 and, of these 8182 patients, 1062 received 10 units of PRBC. First, a logistic regression model for the predictors of mortality was performed. Second, incidences of organ failure and sepsis as well as survival rates were analysed.
Results The highest risk for mortality was age over 55 years (odds ratios [OR] 4·7; confidence intervals [CI 95%], 3·5–6·5) followed by Glasgow Coma Scale 8 (OR 4·6; 3·4–6·1), MBT 20 units of PRBC (OR 3·3; 2·1–5·4), thromboplastin time < 50% (OR 3·2; 2·2–4·4) and injury severity score 24 (OR 2·9; 2·1–4·1). Transfusion of 10–19 PRBC was identified as the variable with the lowest risk for mortality (OR 1·5; 1·0–2·3). Risk of organ failure, sepsis and death correlated with increasing transfusion amount. For the MBT patients, the survival rate was 56·9% (CI 95%, 53·9–59·9%) compared to 85·2% (84·4–86·0%) of non‐MBT patients (P < 0·001). In the MBT group with > 30 PRBC (mean 40·6 PRBC) 39·6% survived (31·7–47·5%).
Conclusion Massive blood transfusion is one main prognostic factor for mortality in trauma. Although MBT is generally considered to be critical, every second trauma patient with MBT survived. A cut‐off value for the number of PRBC could not be determined. Extended transfusion management even with high amounts of PRBC seems to be justified.</description><identifier>ISSN: 0042-9007</identifier><identifier>EISSN: 1423-0410</identifier><identifier>DOI: 10.1111/j.1423-0410.2006.00858.x</identifier><identifier>PMID: 17181593</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Blood Transfusion - mortality ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Germany - epidemiology ; Hemorrhage - complications ; Hemorrhage - mortality ; Hemorrhage - therapy ; Humans ; Intensive Care Units ; Male ; massive blood transfusion ; Middle Aged ; Multiple Organ Failure - etiology ; Multiple Trauma - complications ; Multiple Trauma - mortality ; Multiple Trauma - therapy ; Odds Ratio ; organ failure ; outcome ; polytrauma ; Prognosis ; Prospective Studies ; Registries ; Regression Analysis ; resuscitation ; Risk Factors ; sepsis ; Sepsis - etiology ; Survival Analysis ; Transfusion Reaction</subject><ispartof>Vox sanguinis, 2007-01, Vol.92 (1), p.69-78</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4358-df683b3153f501d9def1b02e3b7d9153bfc073c7e734613990ee332ae18fbd4e3</citedby><cites>FETCH-LOGICAL-c4358-df683b3153f501d9def1b02e3b7d9153bfc073c7e734613990ee332ae18fbd4e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1423-0410.2006.00858.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1423-0410.2006.00858.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17181593$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huber-Wagner, S.</creatorcontrib><creatorcontrib>Qvick, M.</creatorcontrib><creatorcontrib>Mussack, T.</creatorcontrib><creatorcontrib>Euler, E.</creatorcontrib><creatorcontrib>Kay, M. V.</creatorcontrib><creatorcontrib>Mutschler, W.</creatorcontrib><creatorcontrib>Kanz, K.-G.</creatorcontrib><creatorcontrib>Working Group on Polytrauma of German Trauma Society (DGU)</creatorcontrib><creatorcontrib>Working Group on Polytrauma of the German Trauma Society (DGU)</creatorcontrib><title>Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society</title><title>Vox sanguinis</title><addtitle>Vox Sang</addtitle><description>Background and Objectives About 15% of polytrauma patients receive massive blood transfusion (MBT) defined as ≥ 10 units of packed red blood cells (PRBC). In general, the prognosis of trauma patients receiving MBT is considered to be poor. The purpose of this study was to investigate the impact of MBT on the outcome of polytrauma patients.
Materials and Methods Records of 10 997 patients in the Trauma Registry of the German Trauma Society were analysed. Transfusion data were available from 8182 severe trauma patients with a mean injury severity score of 24·5 and, of these 8182 patients, 1062 received 10 units of PRBC. First, a logistic regression model for the predictors of mortality was performed. Second, incidences of organ failure and sepsis as well as survival rates were analysed.
Results The highest risk for mortality was age over 55 years (odds ratios [OR] 4·7; confidence intervals [CI 95%], 3·5–6·5) followed by Glasgow Coma Scale 8 (OR 4·6; 3·4–6·1), MBT 20 units of PRBC (OR 3·3; 2·1–5·4), thromboplastin time < 50% (OR 3·2; 2·2–4·4) and injury severity score 24 (OR 2·9; 2·1–4·1). Transfusion of 10–19 PRBC was identified as the variable with the lowest risk for mortality (OR 1·5; 1·0–2·3). Risk of organ failure, sepsis and death correlated with increasing transfusion amount. For the MBT patients, the survival rate was 56·9% (CI 95%, 53·9–59·9%) compared to 85·2% (84·4–86·0%) of non‐MBT patients (P < 0·001). In the MBT group with > 30 PRBC (mean 40·6 PRBC) 39·6% survived (31·7–47·5%).
Conclusion Massive blood transfusion is one main prognostic factor for mortality in trauma. Although MBT is generally considered to be critical, every second trauma patient with MBT survived. A cut‐off value for the number of PRBC could not be determined. Extended transfusion management even with high amounts of PRBC seems to be justified.</description><subject>Adult</subject><subject>Blood Transfusion - mortality</subject><subject>Emergency Medical Services</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Germany - epidemiology</subject><subject>Hemorrhage - complications</subject><subject>Hemorrhage - mortality</subject><subject>Hemorrhage - therapy</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>massive blood transfusion</subject><subject>Middle Aged</subject><subject>Multiple Organ Failure - etiology</subject><subject>Multiple Trauma - complications</subject><subject>Multiple Trauma - mortality</subject><subject>Multiple Trauma - therapy</subject><subject>Odds Ratio</subject><subject>organ failure</subject><subject>outcome</subject><subject>polytrauma</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Regression Analysis</subject><subject>resuscitation</subject><subject>Risk Factors</subject><subject>sepsis</subject><subject>Sepsis - etiology</subject><subject>Survival Analysis</subject><subject>Transfusion Reaction</subject><issn>0042-9007</issn><issn>1423-0410</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1v1DAQtRCILoW_gHzilsWO49hGXFBFt6BCVSgfN8uJx5AliZfYaTf_gp-M0yzlCL549Oa9N6N5CGFK1jS959s1LXKWkSIBOSHlmhDJ5Xp_D63uGvfRipAizxQh4gg9CmFLEiuX_CE6ooJKyhVboV_vTAjNNeCq9d7iOJg-uDE0vsemt9iPsfYd4KZPs8sc73w7Jc7YGbwzsYE-hhc41YMPO6jjbBTiaCdcmQBJ3uP4HfDVovgA35oQhwl7dwtvYOhM_6f70dcNxOkxeuBMG-DJ4T9Gn05fX52cZecXmzcnr86zumBcZtaVklWMcuY4oVZZcLQiObBKWJXQytVEsFqAYEVJmVIEgLHcAJWusgWwY_Rs8U27_xwhRN01oYa2NT34Mehkr0hRsn8SqeJCqlIkolyIdbpGGMDp3dB0Zpg0JXqOTW_1nI6e09FzbPo2Nr1P0qeHGWPVgf0rPOSUCC8Xwk3TwvTfxvrzxddUJHm2yNP9YX8nN8MPnRYXXH95v9GXp2eXpHjLtWK_AdaJtqc</recordid><startdate>200701</startdate><enddate>200701</enddate><creator>Huber-Wagner, S.</creator><creator>Qvick, M.</creator><creator>Mussack, T.</creator><creator>Euler, E.</creator><creator>Kay, M. V.</creator><creator>Mutschler, W.</creator><creator>Kanz, K.-G.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>200701</creationdate><title>Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society</title><author>Huber-Wagner, S. ; Qvick, M. ; Mussack, T. ; Euler, E. ; Kay, M. V. ; Mutschler, W. ; Kanz, K.-G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4358-df683b3153f501d9def1b02e3b7d9153bfc073c7e734613990ee332ae18fbd4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Blood Transfusion - mortality</topic><topic>Emergency Medical Services</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Germany - epidemiology</topic><topic>Hemorrhage - complications</topic><topic>Hemorrhage - mortality</topic><topic>Hemorrhage - therapy</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>massive blood transfusion</topic><topic>Middle Aged</topic><topic>Multiple Organ Failure - etiology</topic><topic>Multiple Trauma - complications</topic><topic>Multiple Trauma - mortality</topic><topic>Multiple Trauma - therapy</topic><topic>Odds Ratio</topic><topic>organ failure</topic><topic>outcome</topic><topic>polytrauma</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Regression Analysis</topic><topic>resuscitation</topic><topic>Risk Factors</topic><topic>sepsis</topic><topic>Sepsis - etiology</topic><topic>Survival Analysis</topic><topic>Transfusion Reaction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huber-Wagner, S.</creatorcontrib><creatorcontrib>Qvick, M.</creatorcontrib><creatorcontrib>Mussack, T.</creatorcontrib><creatorcontrib>Euler, E.</creatorcontrib><creatorcontrib>Kay, M. V.</creatorcontrib><creatorcontrib>Mutschler, W.</creatorcontrib><creatorcontrib>Kanz, K.-G.</creatorcontrib><creatorcontrib>Working Group on Polytrauma of German Trauma Society (DGU)</creatorcontrib><creatorcontrib>Working Group on Polytrauma of the German Trauma Society (DGU)</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Vox sanguinis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huber-Wagner, S.</au><au>Qvick, M.</au><au>Mussack, T.</au><au>Euler, E.</au><au>Kay, M. V.</au><au>Mutschler, W.</au><au>Kanz, K.-G.</au><aucorp>Working Group on Polytrauma of German Trauma Society (DGU)</aucorp><aucorp>Working Group on Polytrauma of the German Trauma Society (DGU)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society</atitle><jtitle>Vox sanguinis</jtitle><addtitle>Vox Sang</addtitle><date>2007-01</date><risdate>2007</risdate><volume>92</volume><issue>1</issue><spage>69</spage><epage>78</epage><pages>69-78</pages><issn>0042-9007</issn><eissn>1423-0410</eissn><abstract>Background and Objectives About 15% of polytrauma patients receive massive blood transfusion (MBT) defined as ≥ 10 units of packed red blood cells (PRBC). In general, the prognosis of trauma patients receiving MBT is considered to be poor. The purpose of this study was to investigate the impact of MBT on the outcome of polytrauma patients.
Materials and Methods Records of 10 997 patients in the Trauma Registry of the German Trauma Society were analysed. Transfusion data were available from 8182 severe trauma patients with a mean injury severity score of 24·5 and, of these 8182 patients, 1062 received 10 units of PRBC. First, a logistic regression model for the predictors of mortality was performed. Second, incidences of organ failure and sepsis as well as survival rates were analysed.
Results The highest risk for mortality was age over 55 years (odds ratios [OR] 4·7; confidence intervals [CI 95%], 3·5–6·5) followed by Glasgow Coma Scale 8 (OR 4·6; 3·4–6·1), MBT 20 units of PRBC (OR 3·3; 2·1–5·4), thromboplastin time < 50% (OR 3·2; 2·2–4·4) and injury severity score 24 (OR 2·9; 2·1–4·1). Transfusion of 10–19 PRBC was identified as the variable with the lowest risk for mortality (OR 1·5; 1·0–2·3). Risk of organ failure, sepsis and death correlated with increasing transfusion amount. For the MBT patients, the survival rate was 56·9% (CI 95%, 53·9–59·9%) compared to 85·2% (84·4–86·0%) of non‐MBT patients (P < 0·001). In the MBT group with > 30 PRBC (mean 40·6 PRBC) 39·6% survived (31·7–47·5%).
Conclusion Massive blood transfusion is one main prognostic factor for mortality in trauma. Although MBT is generally considered to be critical, every second trauma patient with MBT survived. A cut‐off value for the number of PRBC could not be determined. Extended transfusion management even with high amounts of PRBC seems to be justified.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17181593</pmid><doi>10.1111/j.1423-0410.2006.00858.x</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Blood Transfusion - mortality Emergency Medical Services Emergency Service, Hospital Female Germany - epidemiology Hemorrhage - complications Hemorrhage - mortality Hemorrhage - therapy Humans Intensive Care Units Male massive blood transfusion Middle Aged Multiple Organ Failure - etiology Multiple Trauma - complications Multiple Trauma - mortality Multiple Trauma - therapy Odds Ratio organ failure outcome polytrauma Prognosis Prospective Studies Registries Regression Analysis resuscitation Risk Factors sepsis Sepsis - etiology Survival Analysis Transfusion Reaction |
| title | Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society |
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