title: The impact of platelet transfusion in massively transfused trauma patients.
abstract: BACKGROUND
  The impact of platelet transfusion in trauma patients undergoing a massive transfusion (MT) was evaluated.
  
  
  METHODS
  The Institutional Trauma Registry and Blood Bank Database at a Level I trauma center was used to identify all patients requiring an MT (≥10 packed red blood cells [PRBC] within 24 hours of admission). Mortality was evaluated according to 4 apheresis platelet (aPLT):PRBC ratios: Low ratio (<1:18), medium ratio (≥1:18 and <1:12), high ratio (≥1:12 and <1:6), and highest ratio (≥1:6).
  
  
  RESULTS
  Of 32,289 trauma patients, a total of 657 (2.0%) required an MT. At 24 hours, 171 patients (26.0%) received a low ratio, 77 (11.7%) a medium ratio, 249 (37.9%) a high ratio, and 160 (24.4%) the highest ratio of aPLT:PRBC. After correcting for differences between groups, the mortality at 24 hours increased in a stepwise fashion with decreasing aPLT:PRBC ratio. Using the highest ratio group as a reference, the adjusted relative risk of death was 1.67 (adjusted p = 0.054) for the high ratio group, 2.28 (adjusted p = 0.013) for the medium ratio group, and 5.51 (adjusted p < 0.001) for the low ratio group. A similar stepwise increase in mortality with decreasing platelet ratio was observed at 12 hours after admission and for overall survival to discharge. After stepwise logistic regression, a high aPLT:PRBC ratio (adjusted p < 0.001) was independently associated with improved survival at 24 hours.
  
  
  CONCLUSIONS
  For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warranted.
authors.affiliation: University of Southern California-Keck School of Medicine, Division of Trauma, Emergency Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033-4525, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Ira
authors.initials: I
authors.lastname: Shulman
authors.forename: Janice
authors.initials: J
authors.lastname: Nelson
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D015998:Abbreviated Injury Scale; D001781:Blood Component Removal; D002140:California / Q000453:epidemiology; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017713:Platelet Transfusion / Q000401:mortality*; D012042:Registries; D015996:Survival Rate; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications / Q000401:mortality* / Q000628:therapy*