title: Twenty-four-hour packed red blood cell requirement is the strongest independent prognostic marker of mortality in ED trauma patients.
abstract: BACKGROUND
  Injury severity score, serum lactate, and shock index help the physician determine the severity of injuries present and have been shown to relate to mortality. We sought to determine if an increasing amount of packed red blood cells (PRBCs) given in the first 24hours of admission is an independent predictor of mortality and how it compares to other validated markers.
  
  
  METHODS
  A 6-year retrospective, observational study of adult trauma patients was conducted at a level 1 trauma center. Charts were reviewed for demographic data, amount of PRBC received in the first 24hours, injury severity score, shock index, and lactate levels. Subgroups were used to determine if each variable was an independent predictor of mortality. Correlation coefficients and linear regression were used to determine the strength of correlation between each variable and mortality.
  
  
  RESULTS
  One hundred fifty-seven patients met criteria over a 6-year period. The average age was 28years, 93% were male, and 86% had penetrating injuries. The average injury severity score, serum lactate, and shock index were 18, 6.1, and 0.9, respectively. The average amount of blood given was 6.7 U.
  
  
  CONCLUSIONS
  Twenty-four-hour PRBC requirement is both a novel independent predictor of and has the greatest correlation to mortality in adult trauma patients when compared to injury severity score, shock index, and serum lactate.
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
authors.forename: Albert
authors.initials: A
authors.lastname: Arslan
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Flax
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
authors.forename: Robert
authors.initials: R
authors.lastname: Fraser
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
authors.forename: Marc
authors.initials: M
authors.lastname: Kanter
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
authors.forename: Ronald
authors.initials: R
authors.lastname: Simon
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY. Electronic address: Nicholas.caputo@nychhc.org.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Caputo
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D019344:Lactic Acid / Q000097:blood; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D019344:Lactic Acid