title: Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study.
abstract: OBJECTIVE
  To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients.
  
  
  METHODS
  A retrospective cohort study (1992-2001) including 260 patients receiving >or=10 RBC units <or=24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes.
  
  
  RESULTS
  Patients had a high (mean [standard deviation]) injury severity score (ISS) (42.5 [15.1]), a high admission sequential organ failure assessment (SOFA) score (8.4 [3.8]), and a high hospital mortality (58.5%). They received 38 (25-64) (median [interquartile range]) blood components within 48 hr, including 19 (14-28) RBC units. For 143 patients surviving >or=48 hr, the maximum SOFA score was associated with RBC units transfused before 48 hr (linear regression beta coefficient 0.075, P < 0.0001), lower nadir hemoglobin before 48 hr (0.034, P = 0.03), age (0.032, P = 0.015), and admission SOFA (0.59, P < 0.0001). The RBC units transfused by 48 hr were not associated with either hospital mortality (n = 35) among patients surviving >or=48 hr (independent predictors, age [logistic regression odds ratio (OR) 1.06, 95% confidence interval 1.03-1.10], ISS [OR 1.07, 1.02-1.13], and maximum SOFA score [OR 1.56, 1.27-1.93]) or 48-hr mortality (n = 117) (independent predictors, admission SOFA [1.65, 1.45-1.88] and later year of hospital admission [OR 1.15, 1.02-1.29]).
  
  
  CONCLUSIONS
  Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion.
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Tushar D
authors.initials: TD
authors.lastname: Mahambrey
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Pinto
authors.forename: Terry S
authors.initials: TS
authors.lastname: Smith
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Callum
authors.forename: Nagib S
authors.initials: NS
authors.lastname: Pisani
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data*; D002170:Canada; D015331:Cohort Studies; D003422:Critical Care; D003625:Data Collection; D017707:Erythrocyte Transfusion / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D018401:Sample Size; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*