title: Pretrauma center red blood cell transfusion is associated with reduced mortality and coagulopathy in severely injured patients with blunt trauma.
abstract: OBJECTIVE
  To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients.
  
  
  BACKGROUND
  Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this.
  
  
  METHODS
  Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used.
  
  
  RESULTS
  Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01-0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15-0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02-0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01-0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03-0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01-0.95; P = 0.05).
  
  
  CONCLUSIONS
  PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.
authors.affiliation: *Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA †Department of Surgery, University of California, San Francisco, CA ‡Division of Burn, Trauma, Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX §Division of General Surgery and Trauma, Harborview Medical Center, and the Department of Surgery, University of Washington, Seattle, WA; and ‖Department of Surgery, Denver Health Medical Center, and The University of Colorado Health Sciences Center, Denver, CO.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Brown
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Michaela A
authors.initials: MA
authors.lastname: West
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D004632:Emergency Medical Services; D049071:Endopeptidase Clp; D017707:Erythrocyte Transfusion; D005260:Female; D006360:Heat-Shock Proteins; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D015800:Protozoan Proteins; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality*
chemical_list: D006360:Heat-Shock Proteins; D015800:Protozoan Proteins; D049071:Endopeptidase Clp; C095049:ClpB protein, Leishmania