title: Optimizing Outcomes in the Jehovah's Witness Following Trauma: Special Management Concerns for a Unique Population.
abstract: BACKGROUND
  The objective of this study was to describe the management of the Jehovah's Witness (JW) in an intensely active level I trauma center and review the modern therapeutic options available for the trauma care of these patients.
  
  
  METHODS
  A retrospective review of injured JWs admitted to a busy trauma center over a 13-year period was conducted.
  
  
  RESULTS
  Over the study period, 143 JWs were identified. Among these, 15.4% (22/143) overall and 32.3% (10/31) requiring surgical intensive care unit (SICU) admission accepted transfusion. Overall, 56.6% of JWs (81/143) required operation and 21.7% (31/143) were admitted to the SICU with a complication rate of 4.2% (6/143) and a mortality of 1.4% (2/143). One patient of the 31 patients that were admitted to the SICU received 10 ml of blood with subsequent discontinuation of the transfusion and was excluded from analysis. Of the 30 JWs admitted to the SICU, 20 (66.7%) did not receive transfusion and demonstrated mean admission and nadir hemoglobin (Hb) levels of 12.7 (±2.5) and 9.1 (±3.0) mg/dl, respectively. Ten patients accepted transfusion. This group had longer mean SICU stays (23.3 vs. 5.5 days) but similar mortality (10%, 1/10 vs. 5%, 1/20) compared to non-transfused counterparts. Only one complication (1/20, 5%) was observed in the JWs who were not transfused, compared to a 40% (4/10) complication rate in those accepting transfusion.
  
  
  CONCLUSIONS
  Although our experience was limited, we found no significant difference in the mortality or morbidity between JW patients who received or abstained from transfusion following major trauma. We should keep in mind that the population was small, in order to extract safe conclusions regarding whether we should transfuse or not transfuse trauma patients. We can, however, see interesting insights on the value of trauma resuscitation.
authors.forename: Chrysanthos
authors.initials: C
authors.lastname: Georgiou
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care Department of Surgery, USC + LAC Medical Center University of Southern California, 1200 North State Street, IPT C5L100, Los Angeles, CA, USA. kinaba@surgery.usc.edu.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Joseph
authors.initials: J
authors.lastname: DuBose
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Pantelis
authors.initials: P
authors.lastname: Hadjizacharia
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, USC +LAC Medical Center, University of Southern California, Los Angeles, CA, USA.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
keywords: Blood transfusion; Hemoglobin; Injury; Jehovah’s Witnesses; Outcome assessment; Trauma; Wounds and injuries
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