Profoundly abnormal initial physiologic and biochemical data cannot be used to determine futility in massively transfused trauma patients

Ronald R. Barbosa, Susan E. Rowell, Brian S. Diggs, Martin A. Schreiber, Trauma Outcomes Group The Trauma Outcomes Group

    Research output: Contribution to journalArticle

    9 Scopus citations

    Abstract

    Background: Improvements in prehospital care and resuscitation have led to increases in the number of severely injured patients who are salvageable. Massive transfusion has been increasingly used. Patients often present with markedly abnormal physiologic and biochemical data. The purpose of this study was to identify objective data that can be used to identify clinical futility in massively transfused trauma patients to allow for early termination of resuscitative efforts. Methods: A multicenter database was used. Initial physiologic and biochemical data were obtained, and mortality was determined for patients in the 5th and 10th percentiles for each variable. Raw data from the extreme outliers for each variable were also examined to determine whether a point of excessive mortality could be identified. Injury scoring data were also analyzed. A classification tree model was used to look for variable combinations that predict clinical futility. Results: The cohort included 704 patients. Overall mortality was 40.2%. The highest mortality rates were seen in patients in the 10th percentile for lactate (77%) and pH (72%). Survivors at the extreme ends of the distribution curves for each variable were not uncommon. The classification tree analysis failed to identify any biochemical and physiologic variable combination predictive of >90% mortality. Patients older than 65 years with severe head injuries had 100% mortality. Conclusion: Consideration should be given to withholding massive transfusion for patients older than 65 years with severe head injuries. Otherwise we did not identify any objective variables that reliably predict clinical futility in individual cases. Significant survival rates can be expected even in patients with profoundly abnormal physiologic and biochemical data.

    Original languageEnglish (US)
    Pages (from-to)S364-S369
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume71
    Issue number2 SUPPL. 3
    DOIs
    StatePublished - Aug 1 2011

    Keywords

    • Classification tree
    • Futility
    • Massive transfusion
    • Trauma

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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