J Korean Soc Emerg Med.  2018 Aug;29(4):289-296. 10.0000/jksem.2018.29.4.289.

Validation of critical administration threshold and massive transfusion for mortality prediction in patients with adult severe trauma

• Cho JW
• Seo KS
• Lee MJ
• Park JB
• Kim JK
• Ryoo HW
• Ahn JY
• Moon S
• Lee DE
• Kim YJ
• Choe JY

• KMID: 2435480
• DOI: http://doi.org/10.0000/jksem.2018.29.4.289

Abstract

OBJECTIVE
A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the "massively" transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT.
METHODS
Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality.
RESULTS
A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Forty-two (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040-18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376-8.979).
CONCLUSION
The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.

Keyword

Blood transfusion; Adult; Multiple trauma; Injury Severity Score; Hospital mortality

MeSH Terms

Acidosis
Adult*
Aged
Animals
Bias (Epidemiology)
Blood Transfusion
Brain Injuries
Cats
Erythrocytes
Hospital Mortality
Humans
Injury Severity Score
Logistic Models
Mortality*
Multiple Trauma
Multivariate Analysis
Retrospective Studies
Survivors
Trauma Centers