title: High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries.
abstract: BACKGROUND
  High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage.
  
  
  METHODS
  A retrospective analysis of soldiers injured in the current conflict during 5 years (n = 2,105) who received blood was performed on those with isolated extremity (abbreviated injury scale extremity score > or = 3 and abbreviated injury scale score 0-2 in all other regions) injury comparing those who received a MT with those who did not. Transfusion ratios in the first 24 hours were correlated with outcomes.
  
  
  RESULTS
  Injury severity score (14.6 vs. 12.1; p < 0.05), international normalized ratio (1.65 vs. 1.28; p < 0.05), and base deficit (8.0 vs. 3.7; p < 0.05) were higher in the MT group. High transfusion ratios were associated with a trend toward decreased mortality (17.2% vs. 6.9%; p = 0.07) in MT patients and no increased complications (20.7% vs. 26.4%; p > 0.05). In those receiving a non-MT, high ratios were associated with similar mortality (4.8% vs. 3.9%; p > 0.05) and complications (12.4% vs. 9.2%; p > 0.05).
  
  
  CONCLUSIONS
  Extremity injured patients receiving MT may benefit from high transfusion ratios and do not experience increased complications. No change in mortality or complications was observed in non-MT patients across transfusions ratios. High transfusion ratios are not associated with increased complications in patients with isolated extremity injury regardless of whether a MT is required.
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
authors.forename: Philbert Y
authors.initials: PY
authors.lastname: Van
authors.forename: Chitra N
authors.initials: CN
authors.lastname: Sambasivan
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: John A
authors.initials: JA
authors.lastname: Jones
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008889:Military Personnel; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014857:Warfare