J Korean Soc Traumatol.  2012 Dec;25(4):247-253.

Analysis of the Prognostic Factors in Trauma Patients with Massive Bleeding

Affiliations
  • 1Trauma Center, Seoul National University Hospital, Korea. suhgil@snu.ac.kr
  • 2Department of Surgery, Seoul National University Hospital, Korea.
  • 3Department of Emergency Medicine, Seoul National University Hospital, Korea.
  • 4Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Korea.
  • 5Department of Orthopedic Surgery, Seoul National University Hospital, Korea.
  • 6Department of Neurosurgery, Seoul National University Hospital, Korea.

Abstract

PURPOSE
Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival.
METHODS
This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test.
RESULTS
Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not.
CONCLUSION
The ISS was a prognostic factor for trauma patients with massive bleeding.

Keyword

Trauma; Hemorrhage; Injury severity score; Embolization; Surgery

MeSH Terms

Brain Edema
Cause of Death
Emergencies
Erythrocytes
Hemorrhage
Hemostasis
Humans
Injury Severity Score
Logistic Models
Medical Records
Motor Vehicles
Multiple Organ Failure
Retrospective Studies
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