title: The association of blood component use ratios with the survival of massively transfused trauma patients with and without severe brain injury.
abstract: The effect of blood component ratios on the survival of patients with traumatic brain injury (TBI) has not been studied.
  
  
  
  A database of patients transfused in the first 24 hours after admission for injury from 22 Level I trauma centers over an 18-month period was queried to find patients who (1) met different definitions of massive transfusion (5 units red blood cell [RBC] in 6 hours vs. 10 units RBC in 24 hours), (2) received high or low ratios of platelets or plasma to RBC units (<1:2 vs. ≥ 1:2), and (3) had severe TBI (head abbreviated injury score ≥ 3) (TBI+).
  
  
  
  Of 2,312 total patients, 850 patients were transfused with ≥ 5 RBC units in 6 hours and 807 could be classified into TBI+ (n = 281) or TBI- (n = 526). Six hundred forty-three patients were transfused with ≥ 10 RBC units in 24 hours with 622 classified into TBI+ (n = 220) and TBI- (n = 402). For both high-risk populations, a high ratio of platelets:RBCs (not plasma) was independently associated with improved 30-day survival for patients with TBI+ and a high ratio of plasma:RBCs (not platelets) was independently associated with improved 30-day survival in TBI- patients.
  
  
  
  High platelet ratio was associated with improved survival in TBI+ patients while a high plasma ratio was associated with improved survival in TBI- patients. Prospective studies of blood product ratios should include TBI in the analysis for determination of optimal use of ratios on outcome in injured patients.
authors.affiliation: Department of Pediatrics, St Louis Children's Hospital, St Louis, Missouri 63110, USA. spinella_p@wustl.kids.edu
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mesh_terms: D000328:Adult; D016913:Blood Component Transfusion; D001930:Brain Injuries / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult