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Recent massive blood transfusion practice in England and Wales: view from a trauma registry
  1. Gordon Fuller1,
  2. Omar Bouamra1,
  3. Maralyn Woodford1,
  4. Tom Jenks1,
  5. Simon Stanworth2,
  6. Shubha Allard3,
  7. Timothy J Coats4,
  8. Karim Brohi5,
  9. Fiona Lecky1
  1. 1Trauma Audit and Research Network, Salford Royal Hospital, Salford, UK
  2. 2Haematology Department, John Radcliffe Hospital, Oxford, UK
  3. 3Haematology Deparment, Royal London Hospital, London, UK
  4. 4Emergency Department, Leicester Royal Infirmary, Leicester, UK
  5. 5Trauma Clinical Academic Unit, The Royal London Hospital, London, UK
  1. Correspondence to Dr Gordon Fuller, Trauma Audit and Research Network, Health Sciences Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford, M6 8HD, UK; gordonwfuller{at}doctors.net.uk

Abstract

Background Few studies have characterised massive blood transfusion (MBT) practice in UK trauma. This study describes the Trauma Audit and Research Network experience of MBT over a 4-year period, and examines variables predictive of MBT and mortality following MBT.

Methods Prospectively collected data between 2005 and 2009 from the Trauma Audit and Research Network database were analysed. MBT incidence was examined, and patient characteristics, blood component usage and mortality compared to non-MBT patients. Clinical and injury features predictive of massive transfusion, and risk factors predictive of death in MBT, were analysed using multivariate logistic regression.

Results 157 patients (0.4%) received MBT, with a mortality rate of 40.3%. MBT patients were younger, more likely to be male and to have sustained more severe trauma (median age 39.2 years, median Injury Severity Score 27, 78% male, p<0.01). No patients received platelets and fresh frozen plasma (FFP) in 1:1 ratios with packed red cells. Multivariate analysis showed: age, admission pulse rate, systolic blood pressure, and injury type; thoracic, abdominal, pelvis, were significant predictors of MBT. Injury Severity Score and admission pulse rate were also independent predictors of death in MBT, but level of platelet and FFP use were not found to be statistically significant.

Conclusion MBT is a rare event with high mortality in UK trauma. Haemostatic resuscitation is not currently practiced in the UK and the authors were unable to show that FFP and platelet use were significant predictors of survival in MBT.

  • Red blood cell transfusion
  • blood component transfusion
  • haemorrhagic shock
  • resuscitation
  • military medicine
  • military
  • trauma
  • major trauma management

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Footnotes

  • Funding TARN is self-funding from participating hospitals. The sponsor had no role in design or conduct of the study, data analysis, data interpretation, or writing of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None.

  • Ethics approval The UK Department of Health's Patient Information Advisory Group governs the use of patient information, and has given ethical approval for research using anonymised TARN data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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