title: Effect of high product ratio massive transfusion on mortality in blunt and penetrating trauma patients.
abstract: BACKGROUND
  Recent data suggest that massively transfused patients have lower mortality rates when high ratios (>1:2) of plasma or platelets to red blood cells (RBCs) are used. Blunt and penetrating trauma patients have different injury patterns and may respond differently to resuscitation. This study was performed to determine whether mortality after high product ratio massive transfusion is different in blunt and penetrating trauma patients.
  
  
  METHODS
  Patients receiving 10 or more units of RBCs in the first 24 hours after admission to one of 23 Level I trauma centers were analyzed. Baseline physiologic and biochemical data were obtained. Univariate and logistic regression analyses were performed. Adjusted mortality in patients receiving high (≥ 1:2) and low (<1:2) ratios of plasma or platelets to RBCs was calculated for blunt and penetrating trauma patients.
  
  
  RESULTS
  The cohort contained 703 patients. Blunt injury patients receiving a high ratio of plasma or platelets to RBCs had lower 24-hour mortality (22% vs. 31% for plasma, p = 0.007; 20% vs. 30% for platelets, p = 0.032), but there was no difference in 30-day mortality (40% vs. 44% for plasma, p = 0.085; 37% vs. 44% for platelets, p = 0.063). Patients with penetrating injuries receiving a high plasma:RBC ratio had lower 24-hour mortality (21% vs. 37%, p = 0.005) and 30-day mortality (29% vs. 45%, p = 0.005). High platelet:RBC ratios did not affect mortality in penetrating patients.
  
  
  CONCLUSIONS
  Use of high plasma:RBC ratios during massive transfusion may benefit penetrating trauma patients to a greater degree than blunt trauma patients. High platelet:RBC ratios did not benefit either group.
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA. rowells@ohsu.edu
authors.forename: Susan E
authors.initials: SE
authors.lastname: Rowell
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Barbosa
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
authors.forename: J B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: C E
authors.initials: CE
authors.lastname: Wade
authors.forename: K J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: G
authors.initials: G
authors.lastname: Vercruysse
authors.forename: J
authors.initials: J
authors.lastname: MacLeod
authors.forename: R P
authors.initials: RP
authors.lastname: Dutton
authors.forename: J R
authors.initials: JR
authors.lastname: Hess
authors.forename: J C
authors.initials: JC
authors.lastname: Duchesne
authors.forename: N E
authors.initials: NE
authors.lastname: McSwain
authors.forename: P
authors.initials: P
authors.lastname: Muskat
authors.forename: J
authors.initials: J
authors.lastname: Johannigamn
authors.forename: H M
authors.initials: HM
authors.lastname: Cryer
authors.forename: A
authors.initials: A
authors.lastname: Tillou
authors.forename: M J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: J F
authors.initials: JF
authors.lastname: Pittet
authors.forename: P
authors.initials: P
authors.lastname: Knudson
authors.forename: M A
authors.initials: MA
authors.lastname: De Moya
authors.forename: M A
authors.initials: MA
authors.lastname: Schreiber
authors.forename: B
authors.initials: B
authors.lastname: Tieu
authors.forename: S
authors.initials: S
authors.lastname: Brundage
authors.forename: L M
authors.initials: LM
authors.lastname: Napolitano
authors.forename: M
authors.initials: M
authors.lastname: Brunsvold
authors.forename: K C
authors.initials: KC
authors.lastname: Sihler
authors.forename: G
authors.initials: G
authors.lastname: Beilman
authors.forename: A B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: M S
authors.initials: MS
authors.lastname: Zenait
authors.forename: J
authors.initials: J
authors.lastname: Sperry
authors.forename: L
authors.initials: L
authors.lastname: Alarcon
authors.forename: M A
authors.initials: MA
authors.lastname: Croce
authors.forename: J P
authors.initials: JP
authors.lastname: Minei
authors.forename: R
authors.initials: R
authors.lastname: Kozar
authors.forename: E A
authors.initials: EA
authors.lastname: Gonzalez
authors.forename: R M
authors.initials: RM
authors.lastname: Stewart
authors.forename: S M
authors.initials: SM
authors.lastname: Cohn
authors.forename: J E
authors.initials: JE
authors.lastname: Mickalek
authors.forename: E M
authors.initials: EM
authors.lastname: Bulger
authors.forename: B A
authors.initials: BA
authors.lastname: Cotton
authors.forename: T C
authors.initials: TC
authors.lastname: Nunez
authors.forename: R
authors.initials: R
authors.lastname: Ivatury
authors.forename: J W
authors.initials: JW
authors.lastname: Meredith
authors.forename: P
authors.initials: P
authors.lastname: Miller
authors.forename: G J
authors.initials: GJ
authors.lastname: Pomper
authors.forename: B
authors.initials: B
authors.lastname: Marin
mesh_terms: D000293:Adolescent; D000328:Adult; D016913:Blood Component Transfusion; D004906:Erythrocyte Count; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D014950:Wounds, Penetrating / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult