Early predictors of massive transfusion in patients sustaining torso gunshot wounds in a civilian level I trauma center.
BACKGROUND
Early prediction of the need for massive transfusion (MT) remains difficult. We hypothesized that MT protocol (MTP) utilization would improve by identifying markers for MT (>10 units packed red blood cell [PRBC] in 24 hours) in torso gunshot wounds (GSW) requiring early transfusion and operation.


METHODS
Data from all MTPs were collected prospectively from February 1, 2007, to January 31, 2009. Demographic, transfusion, anatomic, and operative data were analyzed for MT predictors.


RESULTS
Of the 216 MTP activations, 78 (36%) patients sustained torso GSW requiring early transfusion and operation. Five were moribund and died before receiving MT. Of 73 early survivors, 56 received MT (76%, mean 19 units PRBC) and 17 had early bleeding control (EBC), (24%, mean 5 units PRBC). Twelve transpelvic and 13 multicavitary wounds all received MT regardless of initial hemodynamic status (mean systolic blood pressure: 96 mm Hg; range, 50-169). Of 31 MT patients with low-risk trajectories (LRT), 18 (58%) had a systolic blood pressure <90 mm Hg compared with 3 of 17 (17%) in the EBC group (p < 0.01). In these same groups, a base deficit of <-10 was present in 27 of 31 (92%) MT patients versus 4 of 17 (23%) EBC patients (p < 0.01). The presence of both markers identified 97% of patients with LRT who requiring MT and their absence would have potentially eliminated 16 of 17 EBC patients from MTP activation.


CONCLUSIONS
In patients requiring early operation and transfusion after torso GSW: (1) early initiation of MTP is reasonable for transpelvic and multicavitary trajectories regardless of initial hemodynamic status as multiple or difficult to control bleeding sources are likely and (2) early initiation of MTP in patients with LRT may be guided by a combination of hypotension and acidosis, indicating massive blood loss.
Department of Surgery, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, Georgia 30303, USA. cdente@emory.edu
Christopher J
CJ
Dente
Beth H
BH
Shaz
Jeffery M
JM
Nicholas
Robert S
RS
Harris
Amy D
AD
Wyrzykowski
Brooks W
BW
Ficke
Gary A
GA
Vercruysse
David V
DV
Feliciano
Grace S
GS
Rozycki
Jeffrey P
JP
Salomone
Walter L
WL
Ingram
D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000601:surgery*; D014193:Trauma Centers; D014948:Wounds, Gunshot / Q000503:physiopathology / Q000601:surgery*