title: Massive blood transfusions post trauma in the elderly compared to younger patients.
abstract: BACKGROUND
  Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients ≥65 years old and explore variables associated with poor outcomes.
  
  
  METHODS
  A retrospective review of registry data on all major trauma patients presenting to a level I trauma centre between 2006 and 2011 was conducted. Mortality at hospital discharge among patients ≥65 years old was compared to the younger cohort. A multivariable logistic regression model was constructed to determine independent risk-factors for mortality among older patients.
  
  
  RESULTS
  There were 51 (16.4%) patients of age ≥65 years who received a massive transfusion. There were 20 (39.2%) deaths, a proportion significantly higher than 55 (21.1%) deaths among younger patients (p<0.01). Pre-hospital GCS, the presence of acute traumatic coagulopathy and higher systolic blood pressure on presentation were independently associated with higher mortality. Age and volume of red cells transfused were not significantly associated with higher mortality.
  
  
  CONCLUSIONS
  Survival to hospital discharge was demonstrated in elderly patients receiving massive transfusions post trauma, even in the presence of multiple risk factors for mortality. Restrictive resuscitation or transfusion on the basis of age alone cannot be supported. Early aggressive resuscitation of elderly trauma patients along specific guidelines directed at the geriatric population is justified and may further improve outcomes.
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; National Trauma Research Institute, The Alfred Hospital, Australia. Electronic address: b.mitra@alfred.org.au.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Australia; Trauma Service, The Alfred Hospital, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Olaussen
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; National Trauma Research Institute, The Alfred Hospital, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Australia; Trauma Service, The Alfred Hospital, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: O'Donohoe
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Australia; Trauma Service, The Alfred Hospital, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D016913:Blood Component Transfusion / Q000379:methods / Q000401:mortality; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D010949:Plasma; D017410:Practice Guidelines as Topic; D012042:Registries; D012151:Resuscitation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D005340:Fibrinogen
keywords: Blood product transfusion; Elderly; Fresh frozen plasma; Resuscitation; Trauma; Wounds and injuries