Tags

Type your tag names separated by a space and hit enter

Early predictors of massive transfusion in combat casualties.
J Am Coll Surg. 2007 Oct; 205(4):541-5.JA

Abstract

BACKGROUND

An early predictive model for massive transfusion (MT) is critical for management of combat casualties because of limited blood product availability, component preparation, and the time necessary to mobilize fresh whole blood donors. The purpose of this study was to determine which variables, available early after injury, are associated with MT. We hypothesized that International Normalized Ratio and penetrating mechanism would be predictive.

STUDY DESIGN

We performed a retrospective cohort analysis in two combat support hospitals in Iraq. Patients who required MT were compared with patients who did not. Eight potentially predictive variables were subjected to univariate analysis. Variables associated with need for MT were then subjected to stepwise logistic regression.

RESULTS

Two hundred forty-seven patients required MT and 311 did not. Mean Injury Severity Score was 22 in the MT group and 5 in the non-MT group (p < 0.001). Patients in the MT group received 17.9 U stored RBCs and 2.0 U fresh whole blood, versus 1.1 U RBCs and 0.2 U whole blood in the non-MT group (p < 0.001). Mortality was 39% in the MT group and 1% in the non-MT group (p < 0.001). Variables that independently predicted the need for MT were: hemoglobin <or= 11 g/dL, International Normalized Ratio > 1.5, and a penetrating mechanism. The area under the receiver operator characteristic curve was 0.804 and Hosmer-Lemeshow goodness-of-fit test was 0.98.

CONCLUSION

MT after combat injury is associated with high mortality. Simple variables available early after admission allow accurate prediction of MT.

Authors+Show Affiliations

Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA. schreibm@ohsu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17903727

Citation

Schreiber, Martin A., et al. "Early Predictors of Massive Transfusion in Combat Casualties." Journal of the American College of Surgeons, vol. 205, no. 4, 2007, pp. 541-5.
Schreiber MA, Perkins J, Kiraly L, et al. Early predictors of massive transfusion in combat casualties. J Am Coll Surg. 2007;205(4):541-5.
Schreiber, M. A., Perkins, J., Kiraly, L., Underwood, S., Wade, C., & Holcomb, J. B. (2007). Early predictors of massive transfusion in combat casualties. Journal of the American College of Surgeons, 205(4), 541-5.
Schreiber MA, et al. Early Predictors of Massive Transfusion in Combat Casualties. J Am Coll Surg. 2007;205(4):541-5. PubMed PMID: 17903727.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early predictors of massive transfusion in combat casualties. AU - Schreiber,Martin A, AU - Perkins,Jeremy, AU - Kiraly,Laszlo, AU - Underwood,Samantha, AU - Wade,Charles, AU - Holcomb,John B, Y1 - 2007/08/08/ PY - 2007/03/22/received PY - 2007/04/28/revised PY - 2007/05/08/accepted PY - 2007/10/2/pubmed PY - 2007/12/6/medline PY - 2007/10/2/entrez SP - 541 EP - 5 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 205 IS - 4 N2 - BACKGROUND: An early predictive model for massive transfusion (MT) is critical for management of combat casualties because of limited blood product availability, component preparation, and the time necessary to mobilize fresh whole blood donors. The purpose of this study was to determine which variables, available early after injury, are associated with MT. We hypothesized that International Normalized Ratio and penetrating mechanism would be predictive. STUDY DESIGN: We performed a retrospective cohort analysis in two combat support hospitals in Iraq. Patients who required MT were compared with patients who did not. Eight potentially predictive variables were subjected to univariate analysis. Variables associated with need for MT were then subjected to stepwise logistic regression. RESULTS: Two hundred forty-seven patients required MT and 311 did not. Mean Injury Severity Score was 22 in the MT group and 5 in the non-MT group (p < 0.001). Patients in the MT group received 17.9 U stored RBCs and 2.0 U fresh whole blood, versus 1.1 U RBCs and 0.2 U whole blood in the non-MT group (p < 0.001). Mortality was 39% in the MT group and 1% in the non-MT group (p < 0.001). Variables that independently predicted the need for MT were: hemoglobin <or= 11 g/dL, International Normalized Ratio > 1.5, and a penetrating mechanism. The area under the receiver operator characteristic curve was 0.804 and Hosmer-Lemeshow goodness-of-fit test was 0.98. CONCLUSION: MT after combat injury is associated with high mortality. Simple variables available early after admission allow accurate prediction of MT. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/17903727/Early_predictors_of_massive_transfusion_in_combat_casualties_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(07)00625-4 DB - PRIME DP - Unbound Medicine ER -