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Association of shock, coagulopathy, and initial vital signs with massive transfusion in combat casualties.
J Trauma. 2010 Jul; 69 Suppl 1:S26-32.JT

Abstract

BACKGROUND

Timely initiation of a massive transfusion (MT) protocol is associated with improved survival and reduced transfusion for patients requiring MT; however, a priori identification of this population is difficult. The objective of this study was to compare the results of an MT prediction model and actual MT incidence in combat casualties.

METHODS

We performed a retrospective review of the Joint Theater Trauma Registry transfusion database for all US service personnel injured in combat during overseas contingency operations who received at least 1 unit of blood. Systolic blood pressure at the time of admission, heart rate, hemoglobin, international normalized ratio, and base deficit were used in a previously developed prediction model for MT.

RESULTS

Casualties (n = 1124) were identified who had received at least 1 unit of blood and had all data points. Of these patients, 420 patients (37%) received an MT. Subjects presenting with any two of four possible variables (heart rate >110, systolic blood pressure <110 mm Hg, base deficit < or = -6, and hemoglobin <11) had a 54% incidence of MT with a model sensitivity of 69%. Patients predicted but not observed to receive an MT had earlier time of death and an increased incidence of head injuries compared with those predicted and observed to receive an MT. Patients not predicted but observed to receive an MT had increased chest, abdominal, and extremity injuries than those neither predicted nor observed to receive an MT.

CONCLUSION

The decision to implement an MT seems to rely heavily on clinical evaluation of severity of abdominal and extremity injury rather than physiologic derangement. Using a model based on the physiologic parameters--a more objective measure--may decrease mortality in combat casualties.

Authors+Show Affiliations

Department of Surgery, United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA. larsonc@uthscsa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20622616

Citation

Larson, Claire R., et al. "Association of Shock, Coagulopathy, and Initial Vital Signs With Massive Transfusion in Combat Casualties." The Journal of Trauma, vol. 69 Suppl 1, 2010, pp. S26-32.
Larson CR, White CE, Spinella PC, et al. Association of shock, coagulopathy, and initial vital signs with massive transfusion in combat casualties. J Trauma. 2010;69 Suppl 1:S26-32.
Larson, C. R., White, C. E., Spinella, P. C., Jones, J. A., Holcomb, J. B., Blackbourne, L. H., & Wade, C. E. (2010). Association of shock, coagulopathy, and initial vital signs with massive transfusion in combat casualties. The Journal of Trauma, 69 Suppl 1, S26-32. https://doi.org/10.1097/TA.0b013e3181e423f4
Larson CR, et al. Association of Shock, Coagulopathy, and Initial Vital Signs With Massive Transfusion in Combat Casualties. J Trauma. 2010;69 Suppl 1:S26-32. PubMed PMID: 20622616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of shock, coagulopathy, and initial vital signs with massive transfusion in combat casualties. AU - Larson,Claire R, AU - White,Christopher E, AU - Spinella,Philip C, AU - Jones,John A, AU - Holcomb,John B, AU - Blackbourne,Lorne H, AU - Wade,Charles E, PY - 2010/7/13/entrez PY - 2010/8/5/pubmed PY - 2010/9/30/medline SP - S26 EP - 32 JF - The Journal of trauma JO - J Trauma VL - 69 Suppl 1 N2 - BACKGROUND: Timely initiation of a massive transfusion (MT) protocol is associated with improved survival and reduced transfusion for patients requiring MT; however, a priori identification of this population is difficult. The objective of this study was to compare the results of an MT prediction model and actual MT incidence in combat casualties. METHODS: We performed a retrospective review of the Joint Theater Trauma Registry transfusion database for all US service personnel injured in combat during overseas contingency operations who received at least 1 unit of blood. Systolic blood pressure at the time of admission, heart rate, hemoglobin, international normalized ratio, and base deficit were used in a previously developed prediction model for MT. RESULTS: Casualties (n = 1124) were identified who had received at least 1 unit of blood and had all data points. Of these patients, 420 patients (37%) received an MT. Subjects presenting with any two of four possible variables (heart rate >110, systolic blood pressure <110 mm Hg, base deficit < or = -6, and hemoglobin <11) had a 54% incidence of MT with a model sensitivity of 69%. Patients predicted but not observed to receive an MT had earlier time of death and an increased incidence of head injuries compared with those predicted and observed to receive an MT. Patients not predicted but observed to receive an MT had increased chest, abdominal, and extremity injuries than those neither predicted nor observed to receive an MT. CONCLUSION: The decision to implement an MT seems to rely heavily on clinical evaluation of severity of abdominal and extremity injury rather than physiologic derangement. Using a model based on the physiologic parameters--a more objective measure--may decrease mortality in combat casualties. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/20622616/Association_of_shock_coagulopathy_and_initial_vital_signs_with_massive_transfusion_in_combat_casualties_ L2 - https://doi.org/10.1097/TA.0b013e3181e423f4 DB - PRIME DP - Unbound Medicine ER -