SAN FRANCISCO – Giving patients severely injured by blunt trauma a blood transfusion before they arrived at a trauma center was associated with a 95% reduction in deaths within 24 hours and a 64% reduction in deaths within 30 days, a retrospective study of 1,415 patients found.
Transfusion before arrival at the trauma center also was associated with an 88% reduction in the incidence of trauma-induced coagulopathy, Dr. Joshua B. Brown and his associates reported at the annual meeting of the American Association for the Surgery of Trauma.
They analyzed data from the prospective Inflammation and Host Response to Injury cohort study for patients with blunt injury in hemorrhagic shock who arrived at a trauma center within 2 hours of injury, 50 of whom received a blood transfusion before arrival. The investigators found that prearrival blood transfusion was associated with better outcomes after controlling for the effects of demographics, time to the trauma center, the severity of injury and shock, early resuscitation, and other confounders.
These preliminary data are compelling but require prospective validation, said Dr. Brown of the University of Pittsburgh.
Prehospital resuscitation of patients severely injured by blunt trauma has focused on use of crystalloids, and the next logical step is to bring blood-based resuscitation to prehospital settings, he said. Hemorrhage and coagulopathy have been major causes of death in blunt trauma patients.
In the study, patients who got a transfusion before arrival at the trauma center received a median of 1.3 units of blood prearrival. They were more likely to be hypotensive and to have a lower base deficit compared with patients who were not transfused before arrival, suggesting a higher severity of injury and shock in the transfusion group, he said. The groups did not differ significantly in age, gender, or Injury Severity Score.
Patients who received a transfusion before arrival at a trauma center showed a 95% lower 24-hour mortality rate, a 64% lower 30-day mortality rate, and an 88% lower risk of trauma-induced coagulopathy.
In a subsequent matched cohort analysis of 113 patients from the study, those receiving a pre–trauma center transfusion (35 patients) had a 98% reduction in mortality at 24 hours, an 88% reduction in 30-day mortality, and a 99% reduction in the risk of trauma-induced coagulopathy, Dr. Brown reported.
Dr. Brown reported having no financial disclosures.
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