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Association between transfusion volume and survival outcome following trauma: Insight into the limit of transfusion from an analysis of nationwide trauma registry in Japan.
- Source :
-
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 May 01; Vol. 96 (5), pp. 742-748. Date of Electronic Publication: 2023 Nov 13. - Publication Year :
- 2024
-
Abstract
- Background: Whether and how the transfusion volume should be limited in resuscitation after trauma remains unclear. We investigated the association between transfusion volume and survival outcome following trauma.<br />Methods: Using the Japan Trauma Data Bank (2019-2021), we identified patients 18 years or older who received balanced blood transfusion within the first 24 hours of injury. We evaluated the association between the total number of red blood cell (RBC) units transfused and survival at discharge using logistic regression analysis and generalized additive model. Subgroup analyses based on patient characteristics were performed.<br />Results: Overall, 5,123 patients from 165 hospitals were eligible for analysis. The transfusion volume was significantly associated with survival rate. Compared with that of patients receiving 4 to 9 RBC units, the within-hospital odds ratios (95% confidence interval) for survival at discharge were 0.62 (0.55-0.75), 0.32 (0.25-0.40), and 0.15 (0.12-0.20) for those receiving 10 to 19, 20 to 29, and ≥30 U, respectively. The probability of survival decreased consistently without any discernible threshold; however, the survival rates remained >40% and >20% even in patients receiving 50 and 80 RBC units, respectively. Significant interactions were observed between the number of RBC units transfused and each subgroup for survival at discharge.<br />Conclusion: The probability of survival consistently diminished as the transfusion volume increased. The absence of a threshold and lack of exceedingly low probability of survival support massive transfusion when clinicians perceive ongoing transfusion as beneficial. The unique context of each clinical situation must be considered in decision making.<br />Level of Evidence: Therapeutic/Care Management; Level III.<br /> (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Japan epidemiology
Male
Female
Middle Aged
Adult
Aged
Survival Rate
Resuscitation methods
Resuscitation statistics & numerical data
Erythrocyte Transfusion statistics & numerical data
Injury Severity Score
Retrospective Studies
Hospital Mortality
Trauma Centers statistics & numerical data
Registries
Wounds and Injuries mortality
Wounds and Injuries therapy
Blood Transfusion statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2163-0763
- Volume :
- 96
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The journal of trauma and acute care surgery
- Publication Type :
- Academic Journal
- Accession number :
- 37962149
- Full Text :
- https://doi.org/10.1097/TA.0000000000004206