TY - JOUR
T1 - Time to Whole Blood Transfusion in Hemorrhaging Civilian Trauma Patients
T2 - There Is Always Room for Improvement
AU - Hosseinpour, Hamidreza
AU - Magnotti, Louis J.
AU - Bhogadi, Sai Krishna
AU - Anand, Tanya
AU - El-Qawaqzeh, Khaled
AU - Ditillo, Michael
AU - Colosimo, Christina
AU - Spencer, Audrey
AU - Nelson, Adam
AU - Joseph, Bellal
N1 - Publisher Copyright:
© 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - BACKGROUND: Whole blood (WB) is becoming the preferred product for the resuscitation of hemorrhaging trauma patients. However, there is a lack of data on the optimum timing of receiving WB. We aimed to assess the effect of time to WB transfusion on the outcomes of trauma patients. STUDY DESIGN: The American College of Surgeons TQIP 2017 to 2019 database was analyzed. Adult trauma patients who received at least 1 unit of WB within the first 2 hours of admission were included. Patients were stratified by time to first unit of WB transfusion (first 30 minutes, second 30 minutes, and second hour). Primary outcomes were 24-hour and in-hospital mortality, adjusting for potential confounders. RESULTS: A total of 1,952 patients were identified. Mean age and systolic blood pressure were 42 ± 18 years and 101 ± 35 mmHg, respectively. Median Injury Severity Score was 17 [10 to 26], and all groups had comparable injury severities (p = 0.27). Overall, 24-hour and in-hospital mortality rates were 14% and 19%, respectively. Transfusion of WB after 30 minutes was progressively associated with increased adjusted odds of 24-hour mortality (second 30 minutes: Adjusted odds ratio [aOR] 2.07, p = 0.015; second hour: AOR 2.39, p = 0.010) and in-hospital mortality (second 30 minutes: AOR 1.79, p = 0.025; second hour: AOR 1.98, p = 0.018). On subanalysis of patients with an admission shock index >1, every 30-minute delay in WB transfusion was associated with higher odds of 24-hour (aOR 1.23, p = 0.019) and in-hospital (aOR 1.18, p = 0.033) mortality. CONCLUSIONS: Every minute delay in WB transfusion is associated with a 2% increase in odds of 24-hour and in-hospital mortality among hemorrhaging trauma patients. WB should be readily available and easily accessible in the trauma bay for the early resuscitation of hemorrhaging patients.
AB - BACKGROUND: Whole blood (WB) is becoming the preferred product for the resuscitation of hemorrhaging trauma patients. However, there is a lack of data on the optimum timing of receiving WB. We aimed to assess the effect of time to WB transfusion on the outcomes of trauma patients. STUDY DESIGN: The American College of Surgeons TQIP 2017 to 2019 database was analyzed. Adult trauma patients who received at least 1 unit of WB within the first 2 hours of admission were included. Patients were stratified by time to first unit of WB transfusion (first 30 minutes, second 30 minutes, and second hour). Primary outcomes were 24-hour and in-hospital mortality, adjusting for potential confounders. RESULTS: A total of 1,952 patients were identified. Mean age and systolic blood pressure were 42 ± 18 years and 101 ± 35 mmHg, respectively. Median Injury Severity Score was 17 [10 to 26], and all groups had comparable injury severities (p = 0.27). Overall, 24-hour and in-hospital mortality rates were 14% and 19%, respectively. Transfusion of WB after 30 minutes was progressively associated with increased adjusted odds of 24-hour mortality (second 30 minutes: Adjusted odds ratio [aOR] 2.07, p = 0.015; second hour: AOR 2.39, p = 0.010) and in-hospital mortality (second 30 minutes: AOR 1.79, p = 0.025; second hour: AOR 1.98, p = 0.018). On subanalysis of patients with an admission shock index >1, every 30-minute delay in WB transfusion was associated with higher odds of 24-hour (aOR 1.23, p = 0.019) and in-hospital (aOR 1.18, p = 0.033) mortality. CONCLUSIONS: Every minute delay in WB transfusion is associated with a 2% increase in odds of 24-hour and in-hospital mortality among hemorrhaging trauma patients. WB should be readily available and easily accessible in the trauma bay for the early resuscitation of hemorrhaging patients.
UR - http://www.scopus.com/inward/record.url?scp=85163904480&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85163904480&partnerID=8YFLogxK
U2 - 10.1097/XCS.0000000000000715
DO - 10.1097/XCS.0000000000000715
M3 - Article
C2 - 37070752
AN - SCOPUS:85163904480
SN - 1072-7515
VL - 237
SP - 24
EP - 34
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 1
ER -