title: Changes in transfusion practice in multiple injury between 1993 and 2006: a retrospective analysis on 5389 patients from the German Trauma Registry.
abstract: To evaluate transfusion practices in multiple injured patients and to demonstrate changes in the pattern of packed red blood cell (pRBC) transfusions over the last one-and-half decade (1993-2006). A retrospective analysis using the German Trauma Registry database (DGU-Traumaregister) including 29 353 multiple injured patients was conducted. The study population included primary admissions presenting to the emergency room (ER) with clinical and laboratory signs of active haemorrhage [haemoglobin < 9 g x dL(-1), platelets < 90000 xmicroL(-1) and prothrombin time (Quick-value) < 60%]. The pattern of pRBC transfusions was followed from ER to intensive care unit (ICU) admission. A total of 5389 patients with complete data sets were divided into the following three groups according to the year of treatment and analysed: (a) group 1: 1993-1998 (n = 870), (b) group 2: 1999-2002 (n = 2044) and (c) group 3: 2003-2006 (n = 2475). Patients had a mean age of 40.5 (+/-20) years and were predominantly male (67.2%). All patients were substantially injured (mean injury severity score = 32 +/- 15.5) and in 93% the mechanism of injury was blunt. The percentage of patients who received pRBC transfusions between ER and ICU dropped from 72% in 1993-1998 to 54% in 2003-2006 (P < 0.005). Similarly, the percentage of patients receiving mass transfusions (> 10 pRBC units) dropped from 51.3 to 17.1%. This decline was accompanied by lower incidence rates for septic complications, ventilator days, ICU length-of-stay and mortality. pRBC transfusion practices in acute trauma care have changed substantially over the last one-and-half decade and were associated with better outcome.
authors: Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany. Marc.Maegele@t-online.de
authors: Marc
authors: M
authors: Maegele
authors: Rolf
authors: R
authors: Lefering
authors: Thomas
authors: T
authors: Paffrath
authors: Christian
authors: C
authors: Simanski
authors: Sebastian
authors: S
authors: Wutzler
authors: Bertil
authors: B
authors: Bouillon
mesh_terms: D000293:Adolescent; D000328:Adult; D003422:Critical Care / Q000379:methods; D004632:Emergency Medical Services; D017707:Erythrocyte Transfusion; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D012042:Registries; D012189:Retrospective Studies