title: Massive blood transfusion and trauma resuscitation.
abstract: OBJECTIVE
  To review the massive transfusion practice at a Level I adult Trauma Centre during initial trauma reception and resuscitation.
  
  
  METHODS
  All trauma patients presenting to The Alfred Emergency & Trauma Centre and receiving a transfusion of five units or more of packed red blood cells within 4h of presentation over a 26-month period were included in this study. Patient demographics, clinical characteristics, injuries, surgical management and volume of blood transfused were analysed with mortality as the primary endpoint. Initial clinical features and injuries predictive of massive transfusion were also analysed.
  
  
  RESULTS
  There were 119 patients who received a transfusion of five units or more of packed red blood cells (PRBCs) within 4h of presentation. The median Injury Severity Score of this group of patients was 34.0 (IQR 26-48) and mortality was 27.7%. The median number of packed red blood cell transfused was 8.0 (IQR 6-14) in the 1st 4h. Initial clinical features and injuries independently associated with a larger volume of blood transfused were initial hypotension, fractures of the pelvis, kidney injuries, initial acidaemia, and thrombocytopaenia. The Injury Severity Score, initial coagulopathy measured by APTT and the presence of head injuries were the independent predictors of mortality.
  
  
  CONCLUSIONS
  The volume of blood transfused during trauma resuscitation was not found to be an independent predictor of mortality. Prospective studies into transfusion practice and clinical features of patients during the trauma resuscitation phase requiring massive transfusion are needed to establish evidence-based guidelines for massive transfusion.
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia. b.mitra@alfred.org.au
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mori
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Alison
authors.initials: A
authors.lastname: Street
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D017707:Erythrocyte Transfusion / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000401:mortality*; D012151:Resuscitation / Q000379:methods / Q000592:standards*; D012307:Risk Factors; D014193:Trauma Centers / Q000592:standards*; D014739:Victoria / Q000453:epidemiology