title: Blood transfusion and coagulopathy in geriatric trauma patients.
abstract: BACKGROUND
  Trauma resuscitation has undergone a paradigm shift with new emphasis on the early use of blood products and increased proportions of plasma and platelets. However, it is unclear how this strategy is applied or how effective it is in the elderly population. The study aim is to identify differences in transfusion practices and the coagulopathy of trauma in the elderly.
  
  
  METHODS
  Data was prospectively collected on all consecutive patients that met trauma activation criteria at a Level I trauma centre. Data fields included patient demographics, co-morbidities, injury and resuscitation data, laboratory values, thromboelastography (TEG) results, and outcome measures. Elderly patients were defined as those 55 and older. Propensity-score matched analysis was completed for patients receiving blood product transfusion. Patients were matched by gender, mechanism, injury severity score (ISS), head injury, and time from injury.
  
  
  RESULTS
  Total of 628 patients were included, of which 142 (23%) were elderly. Elderly patients were more likely to be female (41% vs. 24%), suffer blunt mechanism of trauma (96% vs. 80%), have higher ISS scores (mean 25.4 vs. 21.6) and mortality (19% vs. 8%). Elderly patients were significantly more likely to receive a blood transfusion (42% vs. 30%), specifically for red cells and plasma. Propensity-matched analysis resulted in no difference in red cell transfusion or mortality. Despite the broad similarities between the matched cohorts, trauma coagulopathy as measured by TEG was less commonly observed in the elderly.
  
  
  CONCLUSIONS
  Our results suggest that elderly trauma patients are more likely to receive blood products when admitted to a trauma centre, though this may be attributed to under-triage. The results also suggest an altered coagulopathic response to traumatic injury which is partially influenced by increased anticoagulant and antiplatelet medication use in the geriatric population.
  
  
  CONCLUSIONS
  It is not clear whether the acute coagulopathy of trauma is equivalent in geriatric patients, and further study is therefore warranted.
authors.affiliation: Department of Surgery, University of Alberta, 205 - 3017 66 St NW, Edmonton, AB, T6K 4B2, Canada. Brett.mador@outlook.com.
authors.forename: Brett
authors.initials: B
authors.lastname: Mador
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H171, Toronto, ON, M4N 3M5, Canada.
authors.forename: Bartolomeu
authors.initials: B
authors.lastname: Nascimento
authors.affiliation: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Hollands
authors.affiliation: Department of Surgery, St. Michael's Hospital, 30 Bond Street, 3-074 Donnelly Wing, Toronto, ON, M5B 1W8, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D057216:Propensity Score; D011446:Prospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood*
keywords: Coagulopathy; Geriatric; Thromboelastography; Transfusion; Trauma