Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Wu, Shao-Chun; Rau, Cheng-Shyuan; Kuo, Pao‐Jen; Liu, Hang-Tsung; Hsu, Shiun-Yuan; Hsieh, Ching-Hua

doi:10.3390/ijerph15102285

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…As a result, the risk of adverse outcomes may be underestimated by the GTOS, especially for patients who require massive transfusions. 15 However, in our study, the predicted risks of morbidity and mortality by GTOS were not significantly different from the observed frequencies ( Figures 4 and 5 ).…”

Section: Discussioncontrasting

confidence: 66%

“…It has been reported that a massive transfusion is associated with various adverse complications and that the units of red blood cells matter when determining the probability of mortality. 15 , 16 Massive amounts of blood transfusion can lead to a variety of serious complications, such as coagulation dysfunction, immunosuppression, respiratory system damage, hypothermia, and infection. 17 In the calculation of GTOS, the influence of the blood transfusion unit on body function was ignored while adding a score of 22 regardless of the blood unit transfused.…”

Section: Discussionmentioning

confidence: 99%

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Predictive Value of the Geriatric Trauma Outcome Score in Older Patients After Trauma: A Retrospective Cohort Study

Zhuang¹,

Feng²,

Tang³

et al. 2022

IJGM

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Purpose The Geriatric Trauma Outcome Score (GTOS) has been developed and indicate to be a valid prognostic tool for the prediction of mortality in geriatric trauma patients (GTPs) during hospitalization. However, the predictive value of the GTOS for morbidity is still unclear. We aimed to evaluate the association between GTOS, morbidity and mortality in GTPs. Patients and Methods We performed a retrospective cohort study between June 1, 2016, and May 31, 2020, and collected data for patients aged 65 years or older. These patients were treated at the Trauma Center of Tongji Hospital, Wuhan, China. Clinical data were retrieved from the trauma registry. The GTOS was calculated with the following formula: age + ISS * 2.5 + 22 (if any packed red blood cells were transfused within 24 hours after admission). The outcomes were mortality, morbidity, length of hospital stay (LOS), and functional outcome at discharge. Results A total of 485 patients were enrolled: 214 (44.1%) were classified into the low-GTOS group, and 271 (55.9%) were classified into the high-GTOS group. The median (IQR) age was 68 (66–71) years; 361 (74.4%) were male. The most common mechanism of injury was vehicle collision (66.4%), followed by falls <2 m (19.6%). The median (IQR) ISS was 18 (14–22). The median (IQR) GCS was 13 (9–15). A high GTOS was associated with high rates of all-cause mortality (13.3% vs 0.9%, P < 0.001), complications (88.2% vs 31.8%, P < 0.001), unplanned intubation (19.2% vs 1.4%, P < 0.001), and unplanned admissions to the intensive care unit (8.5% vs 0.5%, P < 0.001). In multivariable logistic regression analysis, GTOS was associated with morbidity (OR 1.07, 95% CI, 1.05–1.09, p < 0.001) and mortality (OR 1.04, 95% CI, 1.02–1.06, p < 0.001). Conclusion The GTOS is an independent predictor of morbidity and mortality in GTPs, and it will help us identify patients at high risk on admission.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Geriatric Trauma Outcome Score in Older Patients After Trauma: A Retrospective Cohort Study

Zhuang¹,

Feng²,

Tang³

et al. 2022

IJGM

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“…SI was suggested as an accurate tool for identifying early hypovolemic shock, severity of illness, and prognosis, especially in vascular injuries, hemorrhagic events, or trauma patients [ 20 , 21 , 22 , 23 , 24 , 25 ]. SI was also found to be an independent risk factor and a fast guide for the need of massive transfusion after trauma [ 25 , 26 , 27 ], and increased blood transfusion is regarded as an independent risk factor correlating with poor prognosis in trauma patients because of the alteration of cytokine levels and inflammatory processes caused by the transfused blood products [ 20 , 28 ]. Jonas et al concluded that an SI of greater than 0.9 predicts the necessity of intervention for hemostasis with high specificity (93.6%), and by lowering the threshold to ≥0.8, sensitivity is increased to 76.1% [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

Hsu

Mao

Chuang

et al. 2021

IJERPH

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The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

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“…6,28,30,31 Age is one predictor of mortality that has been topic of interest in prior MT studies, with results suggesting older patients had higher mortality rates for a given volume of blood. [39][40][41] Guerrero et al 40 demonstrated that patients aged >65 years old receiving ≥5 units of blood had a statistically significant increased risk of mortality, and also noted that plasma transfusion increased mortality 3-fold. Wu et al 41 analyzed the effects of the number of transfused blood units on mortality outcomes in elderly trauma patients and demonstrated as patients received more units of RBC, the higher their risk of mortality when compared to their younger counterparts.…”

Section: Discussionmentioning

confidence: 99%

Narrative Review: Is There a Transfusion Cutoff Value After Which Nonsurvivability Is Inevitable in Trauma Patients Receiving Ultramassive Transfusion?

Kim

Casem

Baral

et al. 2023

Anesthesia &Amp; Analgesia

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The institution of massive transfusion protocols (MTPs) has improved the timely delivery of large quantities of blood products and improves patient outcomes. In recent years, the cost of blood products has increased, compounded by significant blood product shortages. There is practical need for identification of a transfusion volume in trauma patients that is associated with increased mortality, or a threshold after which additional transfusion is futile and associated with nonsurvivability. This transfusion threshold is often described in the setting of an ultramassive transfusion (UMT). There are few studies defining what constitutes amount or outcomes associated with such large volume transfusion. The purpose of this narrative review is to provide an analysis of existing literature examining the effects of UMT on outcomes including survival in adult trauma patients and to determine whether there is a threshold transfusion limit after which mortality is inevitable. Fourteen studies were included in this review. The data examining the utility of UMT in trauma are of poor quality, and with the variability inherent in trauma patients, and the surgeons caring for them, no universally accepted cutoff for transfusion exists. Not surprisingly, there is a trend toward increasing mortality with increasing transfusions. The decision to continue transfusing is multifactorial and must be individualized, taking into consideration patient characteristics, institution factors, blood bank supply, and most importantly, constant reevaluation of the need for ongoing transfusion rather than blind continuous transfusion until the heart stops.

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Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Cited by 12 publications

References 22 publications

Predictive Value of the Geriatric Trauma Outcome Score in Older Patients After Trauma: A Retrospective Cohort Study

Predictive Value of the Geriatric Trauma Outcome Score in Older Patients After Trauma: A Retrospective Cohort Study

Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

Narrative Review: Is There a Transfusion Cutoff Value After Which Nonsurvivability Is Inevitable in Trauma Patients Receiving Ultramassive Transfusion?

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