title: Activation of Massive Transfusion for Elderly Trauma Patients.
abstract: Massive transfusion protocol (MTP) is used to resuscitate patients in hemorrhagic shock. Our goal was to review MTP use in the elderly. All trauma patients who required activation of MTP at an urban Level I trauma center from January 1, 2011 to December 31, 2013 were reviewed retrospectively. Elderly was defined as age ≥ 60 years. Sixty-six patients had MTP activated: 52 nonelderly (NE) and 14 elderly (E). There were no statistically significant differences between the two cohorts for gender, injury severity score, head abbreviated injury scale, emergency department Glasgow Coma Scale, initial hematocrit, intensive care unit length of stay, or hospital length of stay. Mean age for NE was 35 years and 73 years for E (P < 0.01). Less than half (43%) of E patients with activation of MTP received 10 or more units of blood products compared with 69 per cent of the NE (P = 0.07). Mortality rates were similar in the NE and the E (53%vs 50%, P = 0.80). After multivariate analysis with Glasgow Coma Scale, injury severity score, and blunt versus penetrating trauma, elderly age was not a predictor of mortality after MTP (P = 0.35). When MTP is activated, survival to discharge in elderly trauma patients is comparable to younger patients.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Murry
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Zaw
authors.forename: David M
authors.initials: DM
authors.lastname: Hoang
authors.forename: Devorah
authors.initials: D
authors.lastname: Mehrzadi
authors.forename: Danielle
authors.initials: D
authors.lastname: Tran
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuno
authors.forename: Matthew
authors.initials: M
authors.lastname: Bloom
authors.forename: Nicolas
authors.initials: N
authors.lastname: Melo
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000379:methods*; D002140:California; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*