TY - JOUR
T1 - Massive blood transfusion following older adult trauma
T2 - The effect of blood ratios on mortality
AU - Hohle, Rae D.
AU - Wothe, Jillian K
AU - Hillmann, Benjamin M.
AU - Tignanelli, Christopher J.
AU - Harmon, James V
AU - Vakayil, Victor A
N1 - Publisher Copyright:
© 2022 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.
PY - 2022/12
Y1 - 2022/12
N2 - BACKGROUND: Massive blood transfusion (MBT) following older adult trauma poses unique challenges. Despite extensive evidence on optimal resuscitative strategies in the younger adult patients, there is limited research in the older adult population.METHODS: We used the Trauma Quality Improvement Program (TQIP) database from 2013 to 2017 to identify all patients over 65 years old who received a MBT. We stratified our population into six fresh-frozen plasma:packed red blood cell (FFP:pRBC) ratio cohorts (1:1, 1:2, 1:3, 1:4, 1:5, 1:6+). Our primary outcomes were 24-h and 30-day mortality. We constructed multivariable regression models with 1:1 group as the baseline and adjusted for confounders to estimate the independent effect of blood ratios on mortality.RESULTS: A total of 3134 patients met our inclusion criteria (median age 73 ± 7.6 years, 65% male). On risk-adjusted multivariable analysis, 1:1 FFP:pRBC ratio was independently associated with lowest 24-h mortality (1:2 odds ratio [OR] 1.60, 95% confidence interval [CI] 1.25-2.06, p < 0.001) and 30-day mortality (1:2 OR 1.44, 95% CI 1.15-1.80, p = 0.002).CONCLUSIONS: Compared to all other ratios, the 1:1 FFP:pRBC ratio had the lowest 24-h and 30-day mortality following older adult trauma consistent with findings in the younger adult population.
AB - BACKGROUND: Massive blood transfusion (MBT) following older adult trauma poses unique challenges. Despite extensive evidence on optimal resuscitative strategies in the younger adult patients, there is limited research in the older adult population.METHODS: We used the Trauma Quality Improvement Program (TQIP) database from 2013 to 2017 to identify all patients over 65 years old who received a MBT. We stratified our population into six fresh-frozen plasma:packed red blood cell (FFP:pRBC) ratio cohorts (1:1, 1:2, 1:3, 1:4, 1:5, 1:6+). Our primary outcomes were 24-h and 30-day mortality. We constructed multivariable regression models with 1:1 group as the baseline and adjusted for confounders to estimate the independent effect of blood ratios on mortality.RESULTS: A total of 3134 patients met our inclusion criteria (median age 73 ± 7.6 years, 65% male). On risk-adjusted multivariable analysis, 1:1 FFP:pRBC ratio was independently associated with lowest 24-h mortality (1:2 odds ratio [OR] 1.60, 95% confidence interval [CI] 1.25-2.06, p < 0.001) and 30-day mortality (1:2 OR 1.44, 95% CI 1.15-1.80, p = 0.002).CONCLUSIONS: Compared to all other ratios, the 1:1 FFP:pRBC ratio had the lowest 24-h and 30-day mortality following older adult trauma consistent with findings in the younger adult population.
KW - TQIP
KW - blood ratio
KW - massive blood transfusion
KW - older adult
KW - trauma
UR - https://www.scopus.com/pages/publications/85136562122
UR - https://www.scopus.com/inward/citedby.url?scp=85136562122&partnerID=8YFLogxK
U2 - 10.1111/acem.14580
DO - 10.1111/acem.14580
M3 - Article
C2 - 35943831
AN - SCOPUS:85136562122
SN - 1069-6563
VL - 29
SP - 1422
EP - 1430
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 12
ER -