title: Recent massive blood transfusion practice in England and Wales: view from a trauma registry.
abstract: BACKGROUND
  Few studies have characterised massive blood transfusion (MBT) practice in UK trauma. This study describes the Trauma Audit and Research Network experience of MBT over a 4-year period, and examines variables predictive of MBT and mortality following MBT.
  
  
  METHODS
  Prospectively collected data between 2005 and 2009 from the Trauma Audit and Research Network database were analysed. MBT incidence was examined, and patient characteristics, blood component usage and mortality compared to non-MBT patients. Clinical and injury features predictive of massive transfusion, and risk factors predictive of death in MBT, were analysed using multivariate logistic regression.
  
  
  RESULTS
  157 patients (0.4%) received MBT, with a mortality rate of 40.3%. MBT patients were younger, more likely to be male and to have sustained more severe trauma (median age 39.2 years, median Injury Severity Score 27, 78% male, p<0.01). No patients received platelets and fresh frozen plasma (FFP) in 1:1 ratios with packed red cells. Multivariate analysis showed: age, admission pulse rate, systolic blood pressure, and injury type; thoracic, abdominal, pelvis, were significant predictors of MBT. Injury Severity Score and admission pulse rate were also independent predictors of death in MBT, but level of platelet and FFP use were not found to be statistically significant.
  
  
  CONCLUSIONS
  MBT is a rare event with high mortality in UK trauma. Haemostatic resuscitation is not currently practiced in the UK and the authors were unable to show that FFP and platelet use were significant predictors of survival in MBT.
authors.affiliation: Trauma Audit and Research Network, Salford Royal Hospital, Salford, UK. gordonwfuller@doctors.net.uk
authors.forename: Gordon
authors.initials: G
authors.lastname: Fuller
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Maralyn
authors.initials: M
authors.lastname: Woodford
authors.forename: Tom
authors.initials: T
authors.lastname: Jenks
authors.forename: Simon
authors.initials: S
authors.lastname: Stanworth
authors.forename: Shubha
authors.initials: S
authors.lastname: Allard
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011674:Pulse; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D014852:Wales / Q000453:epidemiology