Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes

Joel Elterman, Karen Brasel, Siobhan Brown, Eileen Bulger, Jim Christenson, Jeffrey D. Kerby, Delores Kannas, Steven Lin, Joseph P. Minei, Sandro Rizoli, Samuel Tisherman, Martin Schreiber

    Research output: Contribution to journalArticle

    28 Citations (Scopus)

    Abstract

    BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76%weremale, and 98%experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p <0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95%CI, 0.74-0.92; p <0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p <0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.

    Original languageEnglish (US)
    Pages (from-to)8-14
    Number of pages7
    JournalJournal of Trauma and Acute Care Surgery
    Volume75
    Issue number1
    DOIs
    StatePublished - Jul 2013

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    Erythrocyte Transfusion
    Glasgow Coma Scale
    Shock
    Blood Pressure
    Hemoglobins
    Survival
    Wounds and Injuries
    Confidence Intervals
    Heart Rate
    Odds Ratio
    Organ Dysfunction Scores
    Glasgow Outcome Scale
    Injury Severity Score
    Emergency Medical Services
    Resuscitation
    Randomized Controlled Trials
    Erythrocytes

    Keywords

    • Resuscitation
    • Transfusion
    • Traumatic brain injury

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes. / Elterman, Joel; Brasel, Karen; Brown, Siobhan; Bulger, Eileen; Christenson, Jim; Kerby, Jeffrey D.; Kannas, Delores; Lin, Steven; Minei, Joseph P.; Rizoli, Sandro; Tisherman, Samuel; Schreiber, Martin.

    In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1, 07.2013, p. 8-14.

    Research output: Contribution to journalArticle

    Elterman, Joel ; Brasel, Karen ; Brown, Siobhan ; Bulger, Eileen ; Christenson, Jim ; Kerby, Jeffrey D. ; Kannas, Delores ; Lin, Steven ; Minei, Joseph P. ; Rizoli, Sandro ; Tisherman, Samuel ; Schreiber, Martin. / Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1. pp. 8-14.
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    abstract = "BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76{\%}weremale, and 98{\%}experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95{\%} confidence interval [CI], 0.74-0.93; p <0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95{\%}CI, 0.74-0.92; p <0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95{\%} CI, 0.19-0.70; p <0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.",
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    author = "Joel Elterman and Karen Brasel and Siobhan Brown and Eileen Bulger and Jim Christenson and Kerby, {Jeffrey D.} and Delores Kannas and Steven Lin and Minei, {Joseph P.} and Sandro Rizoli and Samuel Tisherman and Martin Schreiber",
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    T1 - Transfusion of red blood cells in patients with a prehospital Glasgow Coma Scale score of 8 or less and no evidence of shock is associated with worse outcomes

    AU - Elterman, Joel

    AU - Brasel, Karen

    AU - Brown, Siobhan

    AU - Bulger, Eileen

    AU - Christenson, Jim

    AU - Kerby, Jeffrey D.

    AU - Kannas, Delores

    AU - Lin, Steven

    AU - Minei, Joseph P.

    AU - Rizoli, Sandro

    AU - Tisherman, Samuel

    AU - Schreiber, Martin

    PY - 2013/7

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    N2 - BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76%weremale, and 98%experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p <0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95%CI, 0.74-0.92; p <0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p <0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.

    AB - BACKGROUND: Red blood cell transfusion practices vary, and the optimal hemoglobin for patients with traumatic brain injury has not been established. METHODS: A retrospective review of data collected prospectively as part of a randomized, controlled trial involving emergency medical service agencies within the Resuscitation Outcomes Consortium was conducted. In patients with a Glasgow Coma Scale (GCS) score of 8 or less without evidence of shock (defined by a systolic blood pressure [SBP] G 70 or SBP of 70 to 90 with a heart rate Q108), the association of red blood cell transfusion with 28-day survival, adult respiratory distress syndromeYfree survival, Multiple Organ Dysfunction Score (MODs), and 6-month Extended Glasgow Outcome Scale (GOSE) score was modeled usingmultivariable logistic regressionwith robust SEs adjusting for age, sex, injury severity (Injury Severity Score [ISS]), initial GCS score, initial SBP, highest field heart rate, penetrating injury, fluid use, study site, and hemoglobin (Hgb) level. RESULTS: Atotal of 1,158 patients had amean age of 40, 76%weremale, and 98%experienced blunt trauma. The initialmeanGCS scorewas 5, and the initialmean SBPwas 134. Themean headAbbreviated Injury Scale (AIS) scorewas 3.5.Acategorical interaction of red blood cell transfusion stratified by initialHgb showed thatwhen the firstHgbwas greater than 10 g/dL, volume of packed red blood cell was associated with a decreased 28-day survival (odds ratio, 0.83; 95% confidence interval [CI], 0.74-0.93; p <0.01) and decreased adult respiratory distress syndromeYfree survival (odds ratio, 0.82; 95%CI, 0.74-0.92; p <0.01). When the initial Hgb was greater than 10, each unit of blood transfused increased the MODs by 0.45 (coefficient 95% CI, 0.19-0.70; p <0.01). CONCLUSION: In patients with a suspected traumatic brain injury and no evidence of shock, transfusion of red blood cells was associated with worse outcomes when the initial Hgb was greater than 10.

    KW - Resuscitation

    KW - Transfusion

    KW - Traumatic brain injury

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