title: The use of trauma transfusion pathways for blood component transfusion in the civilian population: a systematic review and meta-analysis.
abstract: This study was undertaken to determine if, amongst civilian trauma patients requiring massive transfusion (MT), the use of a formal trauma transfusion pathway (TTP), in comparison with transfusion without a TTP, is associated with a reduction in mortality, or changes in indices of coagulation, blood product utilisation and complications. A systematic review of three bibliographic databases, reference lists and conference proceedings was conducted. Studies were included if comparisons were made between patients receiving transfusion with and without a TTP. Data were extracted by two independent reviewers on population characteristics, transfusion strategies, blood product utilisation, indices of coagulation, clinical outcomes and complications. Data were pooled using a random effects model and heterogeneity explored. Seven observational studies met all eligibility criteria. Amongst 1801 patients requiring MT, TTPs were associated with a significant reduction in mortality (RR 0·69, 95% CI 0·55, 0·87). No significant increase in the mean number of PRBC transfused between TTP and control patients was seen (MD -1·17 95% CI -2·70, 0·36). When studies assessing only trauma patients were considered, TTPs were associated with a reduction in the mean number of units of plasma transfused (MD -2·63, 95% CI -4·24, -1·01). In summary, the use of TTPs appears to be associated with a reduction in mortality amongst trauma patients requiring MT without a clinically significant increase in the number of PRBC transfused and a potential reduction in plasma transfusion. Effects of TTPs on platelet transfusion, indices of coagulation and complications remain unclear. A randomised controlled trial is warranted.
authors.affiliation: Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada. kelly.vogt@londonhospitals.ca
authors.forename: K N
authors.initials: KN
authors.lastname: Vogt
authors.forename: J A
authors.initials: JA
authors.lastname: Van Koughnett
authors.forename: L
authors.initials: L
authors.lastname: Dubois
authors.forename: D K
authors.initials: DK
authors.lastname: Gray
authors.forename: N G
authors.initials: NG
authors.lastname: Parry
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology; D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D019091:Critical Pathways; D004630:Emergencies; D005069:Evaluation Studies as Topic; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008887:Military Medicine / Q000379:methods; D012107:Research Design; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*