reappraising the concept of massive transfusion in trauma重新评估的概念大量输血的创伤.pdfVIP

Stanworth et al. Critical Care 2010, 14:R239 /content/14/6/R239 RESEARCH Open Access Reappraising the concept of massive transfusion in trauma 1* 2 3 4 5 6 Simon J Stanworth , Timothy P Morris , Christine Gaarder , J Carel Goslings , Marc Maegele , Mitchell J Cohen , 7 7 8 9 10 2,11 Thomas C König , Ross A Davenport , Jean-Francois Pittet , Pär I Johansson , Shubha Allard , Tony Johnson , Karim Brohi7 Abstract Introduction: The massive-transfusion concept was introduced to recognize the dilutional complications resulting from large volumes of packed red blood cells (PRBCs). Definitions of massive transfusion vary and lack supporting clinical evidence. Damage-control resuscitation regimens of modern trauma care are targeted to the early correction of acute traumatic coagulopathy. The aim of this study was to identify a clinically relevant definition of trauma massive transfusion based on clinical outcomes. We also examined whether the concept was useful in that early prediction of massive transfusion requirements could allow early activation of blood bank protocols. Methods: Datasets on trauma admissions over a 1 or 2-year period were obtained from the trauma registries of five large trauma research networks. A fractional polynomial was used to model the transfusion-associated probability of death. A logistic regression model for the prediction of massive transfusion, defined as 10 or more units of red cell transfusions, was developed. Results: In total, 5,693 patient records were available for analysis. Mortality incre