Changes in transfusion practice in multiple injury between 1993 and 2006: a retrospective analysis on 5389 patients from the German Trauma Registry

Abstract

To evaluate transfusion practices in multiple injured patients and to demonstrate changes in the pattern of packed red blood cell (pRBC) transfusions over the last one-and-half decade (1993-2006). A retrospective analysis using the German Trauma Registry database (DGU-Traumaregister) including 29 353 multiple injured patients was conducted. The study population included primary admissions presenting to the emergency room (ER) with clinical and laboratory signs of active haemorrhage [haemoglobin < 9 g x dL(-1), platelets < 90000 xmicroL(-1) and prothrombin time (Quick-value) < 60%]. The pattern of pRBC transfusions was followed from ER to intensive care unit (ICU) admission. A total of 5389 patients with complete data sets were divided into the following three groups according to the year of treatment and analysed: (a) group 1: 1993-1998 (n = 870), (b) group 2: 1999-2002 (n = 2044) and (c) group 3: 2003-2006 (n = 2475). Patients had a mean age of 40.5 (+/-20) years and were predominantly male (67.2%). All patients were substantially injured (mean injury severity score = 32 +/- 15.5) and in 93% the mechanism of injury was blunt. The percentage of patients who received pRBC transfusions between ER and ICU dropped from 72% in 1993-1998 to 54% in 2003-2006 (P < 0.005). Similarly, the percentage of patients receiving mass transfusions (> 10 pRBC units) dropped from 51.3 to 17.1%. This decline was accompanied by lower incidence rates for septic complications, ventilator days, ICU length-of-stay and mortality. pRBC transfusion practices in acute trauma care have changed substantially over the last one-and-half decade and were associated with better outcome.

Epidemiology and risk factors of sepsis after multiple trauma: An analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery*

“…Therefore, this observation represents another possible reason for the decline in sepsis incidence, as discussed previously (25).…”

Risk stratification in trauma and haemorrhagic shock: Scoring systems derived from the TraumaRegister DGU®

“…Considerable changes in the management of severely injured patients over the years could be observed, among them the early substitution of PRBC, Fresh Frozen Plasma (FFP), and others [29][30][31]. These changes in transfusion practice were associated with better outcome [14]. Besides being extremely helpful in clinical research, the early identification of patients at high risk for MT by a scoring system could lead to direct consequences in clinical practice.…”

Reappraising the concept of massive transfusion in trauma

“…Participating trauma centers were the Royal London Hospital, London, UK; Oslo University Hospital Ulleval, Norway; Academic Medical Centre, Amsterdam, the Netherlands; and San Francisco General Hospital, San Francisco, California, USA. Data from The Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (TR-DGU) [21,22] from Germany, which covers more than 100 hospitals, were also included. The datasets included information over a 1-year period (2007) except the Oslo dataset covering 2 years (from June 2005).…”