Blood Transfusion is an Independent Predictor of Mortality after Blunt Trauma

Abstract

Allogeneic blood transfusion is associated with increased morbidity and mortality. The authors evaluated the affect of blood transfusion, independent of injury severity on mortality. The authors conducted a retrospective review of all patients, age ≥18 years with blunt injury admitted to their Level 2 trauma center from 1994 to 2004 by query of the NTRACS trauma registry. Initial systolic blood pressure and heart rate determined the shock index. Logistic regression was used to model the affect of blood transfusion on mortality. Transfusion requirements were categorized as follows: A, 0 U; B, 1 to 2 U; C, 3 to 5 U; D, ≥6 U blood. In this sample of 8215 blunt trauma patients, 324 patients received blood transfusion. Mortality rates between the transfused and nontransfused groups were 15.12 per cent and 1.84 per cent ( P < 0.000) respectively. In the logistic regression model, transfusion category B did not have a significant affect on the odds of death ( P = 0.176); the affect of transfusing 3 to 5 U and ≥6 U had a mortality odds ratio of 3.22 ( P = 0.002) and 4.87 ( P = 0.000) respectively. Transfusing ≥2U blood was strongly associated with mortality in this blunt trauma population. There must be a continuous attempt to limit blood transfusion when feasible and physiologically appropriate.

Impact of Injury Severity on the Inflammatory State and Severe Anemia

“…Following the first week after injury, despite having gained control of bleeding, patients continue to be transfused on average one to two units of packed red blood cells per week, and this has been linked with immune suppression, infectious complications, and increased mortality. [4][5][6] While an acute anemia is diagnosed in the majority of trauma patients admitted to the ICU, anemia has been found to persist for the duration of their critical illness and can last for weeks to months following the initial injury. 2,7 Other than treatment with blood transfusions, persistent injuryassociated anemia has largely been refractory to exogenous erythropoietin (EPO) administration and iron supplementation or transfusion.…”

Cervical Spine AIS 6 – untreatable but survivable

“…Trauma patients with an ISS of 75 are often described as the most severe injuries with the lowest possible survival rate among trauma researchers. In several studies [36,37] researchers excluded this type of patients. But Peng et.…”

Gelatine matrix with human thrombin decreases blood loss in adolescents undergoing posterior spinal fusion for idiopathic scoliosis

“…3,4 Peri-operative allogeneic blood transfusion increases the risk of postoperative infection and transfusion reactions which may slow post-operative recovery. [5][6][7] Randomised clinical trials have shown that using a gelatine matrix with thrombin to assist haemostasis decreases the operating time and intra-operative blood loss of patients undergoing cardiac, 8 general, 9,10 and ENT surgery. 11,12 There are, however, few randomised clinical trials on its use in orthopaedic or spinal surgery.…”