Epidemiology of acute transfusions in major orthopaedic trauma.
OBJECTIVE
The orthopaedic trauma-related blood product usage is largely unknown. Aim of this study was to describe the epidemiology of early (<24 hours of arrival) blood component use in major orthopaedic trauma.


METHODS
12-month prospective observational study.


METHODS
John Hunter Hospital, Level 1 Trauma Center, New South Wales, Australia.


METHODS
64 consecutive trauma admissions identified, who had an orthopaedic injury and required at least 1 unit of packed red blood cells (PRBC) <24 hours of arrival.


METHODS
Epidemiological study.


METHODS
Demographics, orthopaedic injury type, procedure type, injury severity score, timing, place of first unit of transfusion, and blood component volumes were collected. Activation of the massive transfusion protocol was recorded. Primary outcome measures were intensive care unit admission and mortality.


RESULTS
From 965 major trauma admissions, 64 had one or more orthopaedic injuries and were transfused <24 hours. Forty-eight percent (31/64) required massive transfusion protocol activation. Average age was 41 ± 21 years, 73% (47/64) men. Eighty-four percent (54/64) required emergent orthopaedic intervention, 41% (22/54) having multiple procedures. Overall mortality was 13% (8/64). Twenty-five percent (16/64) required ≥10 units of PRBC. Average PRBC use was 7.2 ± 6.6 units and fresh frozen plasma use 4.3 ± 5.2 units. Thirty-nine percent (25/64) had a pelvic ring injury or acetabular fracture. Thirty-seven percent (24/64) had at least one femoral shaft fracture. Twenty patients had a total of 23 tibia fractures.


CONCLUSIONS
Orthopaedic trauma patients consume the majority of the blood products <24 hours among blunt trauma patients. This resource-intensive group requires frequent urgent surgical interventions and intensive care unit admission.


METHODS
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Krisztian
K
Sisak
Michael
M
Manolis
Benjamin M
BM
Hardy
Natalie
N
Enninghorst
Zsolt J
ZJ
Balogh
D000328:Adult; D001803:Blood Transfusion / Q000401:mortality* / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000401:mortality* / Q000534:rehabilitation*; D006470:Hemorrhage / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology; D014600:Utilization Review; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000534:rehabilitation