title: Temporal trends in the treatment of severe traumatic hemorrhage.
abstract: BACKGROUND
  This study examined the evolution of damage control resuscitation (DCR) and outcomes in severe traumatic hemorrhage (STH) at a large Canadian trauma center.
  
  
  METHODS
  This was a retrospective cohort study of trauma patients admitted to a level 1 trauma center between 2005 and 2010, who received 10 or more units of packed red blood cells within 24 hours of admission. Demographic and clinical findings were compared between survivors and nonsurvivors.
  
  
  RESULTS
  Forty-five patients were included. Twenty-five percent of patients were coagulopathic at admission. Early crystalloid use declined over the study period. The mean 24-hour fresh-frozen plasma:platelets:packed red blood cells ratio was 1:1:2. Hemorrhage-related mortality was 69%. No pedestrians survived STH. A total of 1,032 blood product units were used in the first day for nonsurvivors.
  
  
  CONCLUSIONS
  Principles of DCR crept into clinical practice even before the implementation of a formal STH protocol. DCR appeared to reduce the intensive care unit length of stay but not mortality. STH is associated with heavy use of blood bank resources and high mortality rates. Futility of resuscitative efforts may be predictable by mechanism and early physiological markers.
authors.affiliation: Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
authors.forename: Behrouz
authors.initials: B
authors.lastname: Heidary
authors.affiliation: Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Bell
authors.affiliation: Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
authors.forename: Jacqueline T
authors.initials: JT
authors.lastname: Ngai
authors.affiliation: Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Simons
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Chipperfield
authors.affiliation: Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Ave., Vancouver, British Columbia, V5Z 1M9 Canada. Electronic address: morad.hameed@vch.ca.
authors.forename: S Morad
authors.initials: SM
authors.lastname: Hameed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000639:trends; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult