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Tytuł:
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Death by Decade: Establishing a Transfusion Ceiling for Futility in Massive Transfusion.
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Autorzy:
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Morris MC; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Niziolek GM; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Baker JE; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Huebner BR; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Hanseman D; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Makley AT; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Pritts TA; Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
Goodman MD; Department of Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: .
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Źródło:
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The Journal of surgical research [J Surg Res] 2020 Aug; Vol. 252, pp. 139-146. Date of Electronic Publication: 2020 Apr 09.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
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MeSH Terms:
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Medical Futility*
Erythrocyte Transfusion/*standards
Resuscitation/*standards
Shock, Hemorrhagic/*therapy
Wounds and Injuries/*therapy
Adult ; Age Factors ; Aged ; Clinical Decision-Making/methods ; Erythrocyte Transfusion/statistics & numerical data ; Female ; Hospital Mortality ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Practice Guidelines as Topic ; Registries/statistics & numerical data ; Resuscitation/methods ; Resuscitation/statistics & numerical data ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Shock, Hemorrhagic/etiology ; Shock, Hemorrhagic/mortality ; Trauma Centers/standards ; Trauma Centers/statistics & numerical data ; Treatment Outcome ; United States/epidemiology ; Wounds and Injuries/complications ; Wounds and Injuries/diagnosis ; Wounds and Injuries/mortality
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Contributed Indexing:
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Keywords: Elderly; Hemorrhage; Massive transfusion; Resuscitation; Trauma
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Entry Date(s):
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Date Created: 20200413 Date Completed: 20200909 Latest Revision: 20200909
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Update Code:
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20240105
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DOI:
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10.1016/j.jss.2020.03.004
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PMID:
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32278968
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Background: Age and massive transfusion are predictors of mortality after trauma. We hypothesized that increasing age and high-volume transfusion would result in progressively elevated mortality rates and that a transfusion "ceiling" would define futility.
Methods: The Trauma Quality Improvement Program (TQIP) database was queried for 2013-2016 records and our level I trauma registry was reviewed from 2013 to 2018. Demographic, mortality, and blood transfusion data were collected. Patients were grouped by decade of life and by packed red blood cell (pRBC) transfusion requirement (zero units, 1-3 units, or ≥4 units) within 4 h of admission.
Results: TQIP analysis demonstrated an in-hospital mortality risk that increased linearly with age, to an odds ratio of 10.1 in ≥80 y old (P < 0.01). Mortality rates were significantly higher in older adults (P < 0.01) and those with more pRBCs transfused. In massively transfused patients, the transfusion "ceiling" was dependent on age. Owing to the lack granularity in the TQIP database, 230 patients from our institution who received ≥4 units of pRBCs within 4 h of admission were reviewed. On arrival, younger patients had significantly higher heart rates and more severe derangements in lactate levels, base deficits, and pH compared with older patients. There were no differences among age groups in injury severity score, systolic blood pressure, or mortality.
Conclusions: In massively transfused patients, mortality increased with age. However, a significant proportion of older adults were successfully resuscitated. Therefore, age alone should not be considered a contraindication to high-volume transfusion. Traditional physiologic and laboratory criteria indicative of hemorrhagic shock may have reduced reliability with increasing age, and thus providers must have a heightened suspicion for hemorrhage in the elderly. Early transfusion requirements can be combined with age to establish prognosis to define futility to help counsel families regarding mortality after traumatic injury.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
