Impact of prehospital hypothermia on transfusion requirements and outcomes

Marko Bukur, Anoushiravan Amini Hadjibashi, Eric J. Ley, Darren Malinoski, Matthew Singer, Galinos Barmparas, Daniel Margulies, Ali Salim

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes. METHODS: The Los Angeles County Trauma System Database was queried for all patients admitted between 2005 and 2009. Demographics, physiologic parameters, and transfusion requirements were obtained and dichotomized by admission temperatures with a core temperature of less than 36.5°C considered hypothermic. Multivariate analysis was performed to determine factors contributing to transfusion requirements and to derive adjusted odds ratios (AORs) for mortality and rates of adult respiratory distress syndrome and pneumonia. RESULTS: A total of 21,023 patients were analyzed in our study with 44.6% presenting with PH. Hypothermic patients required 26% more fluid resuscitation (p <0.001) in the emergency department and 17% more total blood products (p <0.001) than those who were admitted with a normal temperature. There was a trend toward an increase in emergency department transfusion (8%, p = 0.06). PH was independently associated with the need for a transfusion (AOR, 1.1; p = 0.047), increased mortality (AOR, 2.0; p <0.01), as well as incidence of adult respiratory distress syndrome (AOR, 1.8; p <0.05) and pneumonia (AOR, 2.6; p <0.01). CONCLUSION: PH is associated with increased transfusion and fluid requirements and subsequently worse outcomes. Interventions that correct hypothermia may decrease transfusion requirements and improve outcomes. Prospective studies investigating correction of hypothermia in trauma patients are warranted. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.

Original languageEnglish (US)
Pages (from-to)1195-1201
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number5
DOIs
StatePublished - Nov 2012
Externally publishedYes

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Hypothermia
Odds Ratio
Adult Respiratory Distress Syndrome
Temperature
Mortality
Hospital Emergency Service
Pneumonia
Wounds and Injuries
Los Angeles
Resuscitation
Epidemiologic Studies
Multivariate Analysis
Demography
Databases
Prospective Studies
Incidence

Keywords

  • Blood transfusions
  • Complications
  • Hypothermia
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Impact of prehospital hypothermia on transfusion requirements and outcomes. / Bukur, Marko; Hadjibashi, Anoushiravan Amini; Ley, Eric J.; Malinoski, Darren; Singer, Matthew; Barmparas, Galinos; Margulies, Daniel; Salim, Ali.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 5, 11.2012, p. 1195-1201.

Research output: Contribution to journalArticle

Bukur, M, Hadjibashi, AA, Ley, EJ, Malinoski, D, Singer, M, Barmparas, G, Margulies, D & Salim, A 2012, 'Impact of prehospital hypothermia on transfusion requirements and outcomes', Journal of Trauma and Acute Care Surgery, vol. 73, no. 5, pp. 1195-1201. https://doi.org/10.1097/TA.0b013e31826fc7d9
Bukur, Marko ; Hadjibashi, Anoushiravan Amini ; Ley, Eric J. ; Malinoski, Darren ; Singer, Matthew ; Barmparas, Galinos ; Margulies, Daniel ; Salim, Ali. / Impact of prehospital hypothermia on transfusion requirements and outcomes. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 5. pp. 1195-1201.
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AU - Barmparas, Galinos

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N2 - BACKGROUND: Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes. METHODS: The Los Angeles County Trauma System Database was queried for all patients admitted between 2005 and 2009. Demographics, physiologic parameters, and transfusion requirements were obtained and dichotomized by admission temperatures with a core temperature of less than 36.5°C considered hypothermic. Multivariate analysis was performed to determine factors contributing to transfusion requirements and to derive adjusted odds ratios (AORs) for mortality and rates of adult respiratory distress syndrome and pneumonia. RESULTS: A total of 21,023 patients were analyzed in our study with 44.6% presenting with PH. Hypothermic patients required 26% more fluid resuscitation (p <0.001) in the emergency department and 17% more total blood products (p <0.001) than those who were admitted with a normal temperature. There was a trend toward an increase in emergency department transfusion (8%, p = 0.06). PH was independently associated with the need for a transfusion (AOR, 1.1; p = 0.047), increased mortality (AOR, 2.0; p <0.01), as well as incidence of adult respiratory distress syndrome (AOR, 1.8; p <0.05) and pneumonia (AOR, 2.6; p <0.01). CONCLUSION: PH is associated with increased transfusion and fluid requirements and subsequently worse outcomes. Interventions that correct hypothermia may decrease transfusion requirements and improve outcomes. Prospective studies investigating correction of hypothermia in trauma patients are warranted. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.

AB - BACKGROUND: Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes. METHODS: The Los Angeles County Trauma System Database was queried for all patients admitted between 2005 and 2009. Demographics, physiologic parameters, and transfusion requirements were obtained and dichotomized by admission temperatures with a core temperature of less than 36.5°C considered hypothermic. Multivariate analysis was performed to determine factors contributing to transfusion requirements and to derive adjusted odds ratios (AORs) for mortality and rates of adult respiratory distress syndrome and pneumonia. RESULTS: A total of 21,023 patients were analyzed in our study with 44.6% presenting with PH. Hypothermic patients required 26% more fluid resuscitation (p <0.001) in the emergency department and 17% more total blood products (p <0.001) than those who were admitted with a normal temperature. There was a trend toward an increase in emergency department transfusion (8%, p = 0.06). PH was independently associated with the need for a transfusion (AOR, 1.1; p = 0.047), increased mortality (AOR, 2.0; p <0.01), as well as incidence of adult respiratory distress syndrome (AOR, 1.8; p <0.05) and pneumonia (AOR, 2.6; p <0.01). CONCLUSION: PH is associated with increased transfusion and fluid requirements and subsequently worse outcomes. Interventions that correct hypothermia may decrease transfusion requirements and improve outcomes. Prospective studies investigating correction of hypothermia in trauma patients are warranted. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.

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KW - Complications

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