title: Potentially avoidable blood transfusion during trauma resuscitation.
abstract: BACKGROUND
  Red blood cell (RBC) transfusion is often essential during trauma resuscitation but is associated with high cost and potential adverse outcomes. This study aimed to determine the incidence of potentially avoidable RBC transfusions (PAT) among adult major trauma patients.
  
  
  METHODS
  A retrospective review of data collected by <name blinded> Registry on patients presenting between Jan 2006 and Dec 2011 was conducted. Eligible patients received at least 1 unit of RBC in the first 24h following presentation to the Emergency Department (ED). Episodes of PAT were determined according to haemodynamic stability and post-transfusion haemoglobin levels.
  
  
  RESULTS
  There were 621 patients included, of whom 224 (36.1%; 95% CI: 32.3-40.0) received PAT. Of them, 132 (58.9%) were haemodynamically stable on arrival and did not require a surgical procedure. Patients with PAT had significantly lower injury severity scores (30 vs 34, p<0.01), higher presenting systolic blood pressure (129 vs 112mm Hg, p<0.01) and a lower frequency of a shock index ≥1 (24.1 vs 65.0%, p<0.01), compared to those without PAT. They also had a significantly lower mortality (13.4 vs 21.7%, p<0.01).
  
  
  CONCLUSIONS
  PAT after trauma was common and often delivered to haemodynamically stable patients who did not require surgical procedures. Clinical decision pathways for trauma resuscitation should aim to limit PAT.
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Deparment of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar. Electronic address: b.mitra@alfred.org.au.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Nash
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Deparment of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Trauma Service, The Alfred Hospital, Melbourne, Australia.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Fitzgerald
authors.affiliation: Anaesthesia & Perioperative Medicine, The Alfred Hospital, Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Moloney
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Avoidable; Blood products; Emergency; Red blood cells; Resuscitation; Transfusion; Wounds and injuries