J Trauma
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Improvements in trauma systems and resuscitation have increased survival in severely injured patients. Massive transfusion has been increasingly used in the civilian setting. Objective predictors of mortality have not been well described. This study examined data available in the early postinjury period to identify variables that are predictive of 24-hour- and 30-day mortality in massively transfused trauma patients. ⋯ Glasgow Coma Scale score, pH, heart rate, age, Injury Severity Score, and 6-hour red blood cell transfusion requirement independently predict mortality in massively transfused trauma patients. Models incorporating these data have only a modest ability to predict mortality and should not be used to justify withholding massive transfusion in individual cases.
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The natural history and optimal treatment of upper extremity (UE) deep venous thromboses (DVT's) remains uncertain as does the clinical significance of catheter-associated (CA) UE DVT's. We sought to analyze predictors of UE DVT resolution and hypothesized that anticoagulation will be associated with quicker UE DVT clot resolution and that CA UE DVT's whose catheters are removed will resolve more often than non-CA UE DVT's. ⋯ A majority of UE DVT's are CA, more than half resolve before discharge, and 2% embolize. Anticoagulation does not appear to affect outcomes, but line removal does result in a quicker decrease in clot size.
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Elements of volume resuscitation from hemorrhagic shock, such as amount of blood product and crystalloid administration, have been shown to be associated with multiple organ dysfunction (MOD). However, it is unknown whether these are causative factors or merely markers of an underlying requirement for large-volume resuscitation. We sought to further delineate the relevance of the major individual components of early volume resuscitation to onset of MOD after severe blunt traumatic injury. ⋯ When controlling for all major components of acute volume resuscitation, massive-transfusion volumes of PRBC's within the first 12 hours of resuscitation are modestly associated with MOD, whereas FFP and large volume crystalloid administration are not independently associated with MOD. Previous reported associations of blood products and large-volume crystalloid with MOD may be reflecting overall resuscitation requirements and burden of injury rather than independent causation.
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Improvements in prehospital care and resuscitation have led to increases in the number of severely injured patients who are salvageable. Massive transfusion has been increasingly used. Patients often present with markedly abnormal physiologic and biochemical data. The purpose of this study was to identify objective data that can be used to identify clinical futility in massively transfused trauma patients to allow for early termination of resuscitative efforts. ⋯ Consideration should be given to withholding massive transfusion for patients older than 65 years with severe head injuries. Otherwise we did not identify any objective variables that reliably predict clinical futility in individual cases. Significant survival rates can be expected even in patients with profoundly abnormal physiologic and biochemical data.
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The effect of blood component ratios on the survival of patients with traumatic brain injury (TBI) has not been studied. ⋯ High platelet ratio was associated with improved survival in TBI+ patients while a high plasma ratio was associated with improved survival in TBI- patients. Prospective studies of blood product ratios should include TBI in the analysis for determination of optimal use of ratios on outcome in injured patients.