Outcome analysis of blood product transfusion in trauma patients: a prospective, risk-adjusted study.
BACKGROUND
Studies have confirmed adverse outcome associated with transfusion of packed red blood cells (PRBCs) in trauma; however, little data are available regarding other blood product transfusion, such as fresh frozen plasma (FFP) and platelets. The objective of this study was to examine risk-adjusted outcome in trauma with stratification by blood product type.


METHODS
Prospective data were collected daily for 1,172 consecutive trauma patients admitted to the intensive care unit (ICU) during a 2-year period, including transfusion rates of blood products (PRBCs, FFP, platelets). Outcome assessment included infection rate, ventilator days (Vdays), ICU and hospital length of stay (LOS), and mortality.


RESULTS
Blood products were transfused in 786 (67%) patients. The study cohort had a mean age of 43 +/- 21 years and Injury Severity Score (ISS) of 24 +/- 13. Although the majority of patients were men, women were more likely to be transfused (p < 0.001). Mean transfusion rates of PRBCs (5.5 +/- 9.6 U), FFP (5.4 +/- 11.4), and platelets (3.7 +/- 11.1) were high. Univariate analysis identified that blood product transfusion (any type) was associated with a significantly greater infection rate (34% vs. 9.4%; p < 0.001), hospital LOS (18.6 vs. 9 days; p < 0.001), ICU LOS (13.7 vs. 7.4 days; p < 0.001), Vdays (12.9 vs. 6.3 days; p < 0.001), and mortality (19% vs. 8.3%; p < 0.001). Multivariate analysis (risk-adjusted for severity of injury by ISS, age, sex, and race, and stratified by blood product type) confirmed that risk of infection increased by 5%, and hospital LOS, ICU LOS, and Vdays increased by 0.64, 0.42, and 0.47 days, respectively, for every unit of PRBCs given. Risk of death increased by 3.5% for every unit of FFP transfused.


CONCLUSIONS
There is a dose-dependent correlation between blood product transfusion and adverse outcome (increased mortality and infection) in trauma patients.
R. Adams Cowley Shock Trauma Center Programs in Trauma, 22 South Greene Street, Baltimore, MD 21201, USA. gbochicchio@umm.edu
Grant V
GV
Bochicchio
Lena
L
Napolitano
Manjari
M
Joshi
Kelly
K
Bochicchio
Walter
W
Meyer
Thomas M
TM
Scalea
D000328:Adult; D001424:Bacterial Infections / Q000209:etiology; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006400:Hematocrit; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications / Q000628:therapy*