CLINICAL IMPACT OF TRANSFUSION STRATEGY WITH PLASMA/RED BLOOD CELL CONDENTRATES≧1 IN SEVERELY TRAUMATIZED PATIENTS REQUIRING EARLY TRANSFUSION : A MULTICENTRE, RETROSPECTIVE COHORT STUDY

Abstract

  Background : Earlier transfusion strategy has been associated with improved outcomes in trauma patients requiring massive transfusion ; however, the importance of transfusion strategy in patients requiring transfusion in the early phase has not been evaluated. Objective : To determine the predictors for patients requiring transfusion within 6hr, and evaluate the effective strategy. Design and patients : In the JOCTET, a multicenter, retrospective observational study, data were collected from trauma patients, age≧18 years and with ISS≧16. Results : Ten or more units of red blood cell (RBC) transfusion were performed in 121 of 207 patients (58.5%) requiring transfusion within 6hr. For prediction of massive transfusion, the specificity of abdominal AIS≧3 was 95.4%, and negative predictive value of heart rate≧90/min and/or lactate≧2.5 mmol/L was more than 90%. In a logistic regression analysis, plasma/RBC≧1 within 6hr was independently associated with decreased 28–day mortality (odds ratio 0.285, P=.016). In a Cox regression model using inverse probability of treatment weighting, plasma/RBC≧1 within 6hr was associated with hospital mortality (hazard ratio 0.51, P<.001). Conclusions : Plasma/RBC≧1 within 6hr was associated with decreased mortality in patients requiring transfusion in the early phase. First order of blood transfusion for severe trauma patients is RBC and plasma by each 10 unitis.