Decreased mortality in patients with isolated severe blunt traumatic brain injury receiving higher plasma to packed red blood cells transfusion ratios

Tobias Haltmeier; Elizabeth Benjamin; John Peter Gruen; Ira A Shulman; Lydia Lam; Kenji Inaba; Demetrios Demetriades

doi:10.1016/j.injury.2017.07.035

Decreased mortality in patients with isolated severe blunt traumatic brain injury receiving higher plasma to packed red blood cells transfusion ratios

Injury. 2018 Jan;49(1):62-66. doi: 10.1016/j.injury.2017.07.035. Epub 2017 Aug 5.

Authors

Tobias Haltmeier¹, Elizabeth Benjamin², John Peter Gruen³, Ira A Shulman⁴, Lydia Lam¹, Kenji Inaba¹, Demetrios Demetriades¹

Affiliations

¹ Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
² Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: Elizabeth.Benjamin@med.usc.edu.
³ Department of Neurological Surgery, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
⁴ Department of Pathology, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.

PMID: 28807428
DOI: 10.1016/j.injury.2017.07.035

Abstract

Introduction: Higher transfusion ratios of plasma to packed red blood cells (PRBC) and platelets (PLT) to PRBC have been shown to be associated with decreased mortality in major trauma patients. However, little is known about the effect of transfusion ratios on mortality in patients with isolated severe traumatic brain injury (TBI). The aim of this study was to investigate the effect of transfusion ratios on mortality in patients with isolated severe blunt TBI. We hypothesized that higher transfusion ratios of plasma to PRBC and PLT to PRBC are associated with a lower mortality rate in these patients.

Methods: Retrospective observational study. Patients with isolated severe blunt TBI (AIS head≥3, AIS extracranial <3) admitted to an urban level I trauma centre were included. Clinical data were extracted from the institution's trauma registry, blood transfusion data from the blood bank database. The effect of higher transfusion ratios on in-hospital mortality was analysed using univariate and multivariable regression analysis.

Results: A total of 385 patients were included. Median age was 32 years (IQR 2-50), 71.4% were male, and 76.6% had an ISS≥16. Plasma:PRBC transfusion ratios≥1 were identified as an independent predictor for decreased in-hospital mortality (adjusted OR 0.43 [CI 0.22-0.81]). PLT:PRBC transfusion ratios≥1 were not significantly associated with mortality (adjusted OR 0.39 [CI 0.08-1.92]).

Conclusion: This study revealed plasma to PRBC transfusion ratios≥1 as an independent predictor for decreased in-hospital mortality in patients with isolated severe blunt TBI.

Keywords: Blood component transfusion; Brain injury; Coagulopathy; Mortality; Transfusion ratio.

Publication types

Observational Study

MeSH terms

Adolescent
Adult
Blood Component Transfusion / methods*
Brain Injuries, Traumatic / mortality
Brain Injuries, Traumatic / therapy*
Child
Child, Preschool
Female
Humans
Injury Severity Score
Male
Middle Aged
Retrospective Studies
Shock, Hemorrhagic / mortality
Shock, Hemorrhagic / prevention & control*
Survival Analysis
Trauma Centers*
Treatment Outcome
Wounds, Nonpenetrating / mortality
Wounds, Nonpenetrating / therapy*
Young Adult