title: Utilisation of Blood Components in Trauma Surgery: A Single-Centre, Retrospective Analysis before and after the Implementation of an Educative PBM Initiative.
abstract: BACKGROUND
  The aim of our single-centre retrospective study presented here is to further analyse the utilisation of allogeneic blood components within a 5-year observation period (2009-2013) in trauma surgery (15,457 patients) under the measures of an educational patient blood management (PBM) initiative.
  
  
  METHODS
  After the implementation of the PBM initiative in January 2012, the Institute of Transfusion Medicine und Transplantation Immunology educates surgeons and nurses at the Department of Trauma Surgery to avoid unnecessary blood transfusions. A standardised reporting system was used to document the utilisation of blood components carefully for the most frequent diagnoses and surgical interventions in trauma surgery. These measures served as basis for the implementation of an interdisciplinary systematic exchange of information to foster decision-making processes in favour of patient blood management.
  
  
  RESULTS
  Since January 2012, the proportion of patients who received a transfusion as well as the number of transfused red blood cell (RBC) (7.3%/6.4%; p = 0.02), fresh frozen plasma (FFP) (1.7%/1.3%; p < 0.05) and platelet (PLT) (1.0%/0.5%; p < 0.001) units were reduced as a result of our PBM initiative. However, among the transfused patients, the number of administered RBC, FFP and PLT units did not decrease significantly. Overall, patients who did not receive transfusions were younger than transfused patients (p = 0.001). The subgroup with the highest probability of blood transfusion administered included patients with intensive care and long-term ventilation (before/after implementation of PBM: RBC 81.5%/75.9%; FFP 33.3%/20.4%; PLT 24.1%/13.0%). Only a total of 60 patients of 531 patients suffering multiple traumas were massively transfused (before/after implementation of PBM: RBC 55.6%/49.8%; FFP 28.4%/20.4%; PLT 17.6%/8.9%).
  
  
  CONCLUSIONS
  According to our educational PBM initiative, at least the proportion of trauma patients who received allogeneic blood transfusions could be reduced significantly. However, in case of blood transfusions, the total consumption of RBC, FFP and PLT units remained stable in both time periods. This phenomenon might indicate that the actual need of blood transfusions rather depends on the severity of trauma-related blood loss, the coagulopathy rates or the complexity of the surgical intervention which mainly determines the intra-operative blood loss. Taken together, educational training sessions and systematic reporting systems are suitable measures to avoid unnecessary allogeneic blood transfusions and to continuously improve their restrictive application.
authors.affiliation: Institute for Transfusion Medicine and Transplantation Immunology, University Hospital of Münster, Münster, Germany.
authors.forename: Raoul Georg
authors.initials: RG
authors.lastname: Geissler
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Münster, Münster, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kösters
authors.affiliation: DRG Research Group and Medical Management, University Hospital of Münster, Münster, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Franz
authors.affiliation: DRG Research Group and Medical Management, University Hospital of Münster, Münster, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Buddendick
authors.affiliation: Institute for Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Borowski
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Münster, Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Juhra
authors.affiliation: Institute for Anaesthesiology, Surgical Intensive Care and Pain Therapy, University Hospital of Münster, Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lange
authors.affiliation: DRG Research Group and Medical Management, University Hospital of Münster, Münster, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Bunzemeier
authors.affiliation: DRG Research Group and Medical Management, University Hospital of Münster, Münster, Germany ; Board of the Hospital, University Hospital of Münster, Münster, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Roeder
authors.affiliation: Institute for Transfusion Medicine and Transplantation Immunology, University Hospital of Münster, Münster, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Sibrowski
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Münster, Münster, Germany.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.affiliation: Institute for Transfusion Medicine and Transplantation Immunology, University Hospital of Münster, Münster, Germany ; Department of Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Schlenke
keywords: Blood supply; Haemotherapy; Health services research; Patient blood management; Trauma surgery