High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries

Philbert Van, Chitra N. Sambasivan, Charles E. Wade, John A. Jones, John B. Holcomb, Martin Schreiber, Lorne H. Blackbourne

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    BACKGROUND: High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage.

    METHODS: A retrospective analysis of soldiers injured in the current conflict during 5 years (n = 2,105) who received blood was performed on those with isolated extremity (abbreviated injury scale extremity score > or = 3 and abbreviated injury scale score 0-2 in all other regions) injury comparing those who received a MT with those who did not. Transfusion ratios in the first 24 hours were correlated with outcomes.

    RESULTS: Injury severity score (14.6 vs. 12.1; p < 0.05), international normalized ratio (1.65 vs. 1.28; p < 0.05), and base deficit (8.0 vs. 3.7; p < 0.05) were higher in the MT group. High transfusion ratios were associated with a trend toward decreased mortality (17.2% vs. 6.9%; p = 0.07) in MT patients and no increased complications (20.7% vs. 26.4%; p > 0.05). In those receiving a non-MT, high ratios were associated with similar mortality (4.8% vs. 3.9%; p > 0.05) and complications (12.4% vs. 9.2%; p > 0.05).

    CONCLUSIONS: Extremity injured patients receiving MT may benefit from high transfusion ratios and do not experience increased complications. No change in mortality or complications was observed in non-MT patients across transfusions ratios. High transfusion ratios are not associated with increased complications in patients with isolated extremity injury regardless of whether a MT is required.

    Original languageEnglish (US)
    Pages (from-to)S64-S68
    JournalThe Journal of trauma
    Volume69
    DOIs
    StatePublished - Jul 1 2010

    Fingerprint

    Extremities
    Abbreviated Injury Scale
    Wounds and Injuries
    Injury Severity Score
    Survival
    Mortality
    Military Personnel
    Erythrocytes
    Hemorrhage

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

    Cite this

    High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries. / Van, Philbert; Sambasivan, Chitra N.; Wade, Charles E.; Jones, John A.; Holcomb, John B.; Schreiber, Martin; Blackbourne, Lorne H.

    In: The Journal of trauma, Vol. 69, 01.07.2010, p. S64-S68.

    Research output: Contribution to journalArticle

    Van, Philbert ; Sambasivan, Chitra N. ; Wade, Charles E. ; Jones, John A. ; Holcomb, John B. ; Schreiber, Martin ; Blackbourne, Lorne H. / High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries. In: The Journal of trauma. 2010 ; Vol. 69. pp. S64-S68.
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    abstract = "BACKGROUND: High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage.METHODS: A retrospective analysis of soldiers injured in the current conflict during 5 years (n = 2,105) who received blood was performed on those with isolated extremity (abbreviated injury scale extremity score > or = 3 and abbreviated injury scale score 0-2 in all other regions) injury comparing those who received a MT with those who did not. Transfusion ratios in the first 24 hours were correlated with outcomes.RESULTS: Injury severity score (14.6 vs. 12.1; p < 0.05), international normalized ratio (1.65 vs. 1.28; p < 0.05), and base deficit (8.0 vs. 3.7; p < 0.05) were higher in the MT group. High transfusion ratios were associated with a trend toward decreased mortality (17.2{\%} vs. 6.9{\%}; p = 0.07) in MT patients and no increased complications (20.7{\%} vs. 26.4{\%}; p > 0.05). In those receiving a non-MT, high ratios were associated with similar mortality (4.8{\%} vs. 3.9{\%}; p > 0.05) and complications (12.4{\%} vs. 9.2{\%}; p > 0.05).CONCLUSIONS: Extremity injured patients receiving MT may benefit from high transfusion ratios and do not experience increased complications. No change in mortality or complications was observed in non-MT patients across transfusions ratios. High transfusion ratios are not associated with increased complications in patients with isolated extremity injury regardless of whether a MT is required.",
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    T1 - High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries

    AU - Van, Philbert

    AU - Sambasivan, Chitra N.

    AU - Wade, Charles E.

    AU - Jones, John A.

    AU - Holcomb, John B.

    AU - Schreiber, Martin

    AU - Blackbourne, Lorne H.

    PY - 2010/7/1

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    N2 - BACKGROUND: High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage.METHODS: A retrospective analysis of soldiers injured in the current conflict during 5 years (n = 2,105) who received blood was performed on those with isolated extremity (abbreviated injury scale extremity score > or = 3 and abbreviated injury scale score 0-2 in all other regions) injury comparing those who received a MT with those who did not. Transfusion ratios in the first 24 hours were correlated with outcomes.RESULTS: Injury severity score (14.6 vs. 12.1; p < 0.05), international normalized ratio (1.65 vs. 1.28; p < 0.05), and base deficit (8.0 vs. 3.7; p < 0.05) were higher in the MT group. High transfusion ratios were associated with a trend toward decreased mortality (17.2% vs. 6.9%; p = 0.07) in MT patients and no increased complications (20.7% vs. 26.4%; p > 0.05). In those receiving a non-MT, high ratios were associated with similar mortality (4.8% vs. 3.9%; p > 0.05) and complications (12.4% vs. 9.2%; p > 0.05).CONCLUSIONS: Extremity injured patients receiving MT may benefit from high transfusion ratios and do not experience increased complications. No change in mortality or complications was observed in non-MT patients across transfusions ratios. High transfusion ratios are not associated with increased complications in patients with isolated extremity injury regardless of whether a MT is required.

    AB - BACKGROUND: High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage.METHODS: A retrospective analysis of soldiers injured in the current conflict during 5 years (n = 2,105) who received blood was performed on those with isolated extremity (abbreviated injury scale extremity score > or = 3 and abbreviated injury scale score 0-2 in all other regions) injury comparing those who received a MT with those who did not. Transfusion ratios in the first 24 hours were correlated with outcomes.RESULTS: Injury severity score (14.6 vs. 12.1; p < 0.05), international normalized ratio (1.65 vs. 1.28; p < 0.05), and base deficit (8.0 vs. 3.7; p < 0.05) were higher in the MT group. High transfusion ratios were associated with a trend toward decreased mortality (17.2% vs. 6.9%; p = 0.07) in MT patients and no increased complications (20.7% vs. 26.4%; p > 0.05). In those receiving a non-MT, high ratios were associated with similar mortality (4.8% vs. 3.9%; p > 0.05) and complications (12.4% vs. 9.2%; p > 0.05).CONCLUSIONS: Extremity injured patients receiving MT may benefit from high transfusion ratios and do not experience increased complications. No change in mortality or complications was observed in non-MT patients across transfusions ratios. High transfusion ratios are not associated with increased complications in patients with isolated extremity injury regardless of whether a MT is required.

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