title: The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?
abstract: BACKGROUND
  Massive transfusion protocol (MTP) is increasingly used in civilian trauma cases to achieve better haemostatic resuscitation in patients requiring massive blood transfusions (MTs), with improved survival outcomes. However, in non-trauma patients, evidence for MTP is lacking. This study aims to assess the outcomes of a newly established MTP in a civilian setting, for both trauma and non-trauma patients, in an acute surgical care unit.
  
  
  METHODS
  A retrospective cohort analysis was performed on 46 patients for whom MTP was activated in Changi General Hospital, Singapore. The patients were categorised into trauma and non-trauma groups. Assessment of Blood Consumption (ABC) score was used to identify MTP trauma patients and analyse over-activation rates.
  
  
  RESULTS
  Only 39.1% of all cases with MTP activation eventually received MTs; 39.8% of the MTs were for non-trauma patients. Mean fresh frozen plasma to packed red blood cells (pRBC) ratio achieved with MTP was 0.741, while mean platelet to pRBC ratio was 0.213. The 24-hour mortality rate for all patients who received an MT upon MTP activation was 33.3% (trauma vs. non-trauma group: 45.5% vs. 14.3%). The ABC scoring system used for trauma patients had a sensitivity and specificity of 81.8% and 41.2%, respectively.
  
  
  CONCLUSIONS
  MTP may be used for both trauma and non-trauma patients in acute care surgery. Scoring systems to predict the need for an MT, improved compliance to predefined transfusion ratios and regular reviews of the MTP are necessary to optimise MTPs and to improve the outcomes of patients receiving MTs.
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Wijaya
authors.affiliation: Ministry of Health Holdings Pte Ltd, Singapore.
authors.forename: Hui Min Gloria
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Department of General Surgery, Changi General Hospital, Singapore.
authors.forename: Chee Keong
authors.initials: CK
authors.lastname: Chong
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods* / Q000639:trends; D005260:Female; D006296:Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010949:Plasma; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*
keywords: blood components; massive transfusion protocol; mortality; scoring system; trauma