Background Hemorrhage is the leading cause of survivable death in trauma. Resuscitation strategies including early red blood cell (RBC) transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients. Study Design Retrospective cohort study of trauma patients transported by helicopter to a level-I trauma center, 2007—2012. Patients receiving PTC RBC transfusion were matched to control patients (receiving no PTC RBC transfusion during transport) in a 1:2 ratio using a propensity-score based on prehospital variables. Conditional logistic regression and mixed-effects linear regression were used to determine the association of PTC RBC transfusion with outcomes. Subgroup analysis was performed for scene transport patients. Results Two-hundred forty treatment patients were matched to 480 control patients receiving no PTC RBC transfusion. PTC RBC transfusion was associated with increased odds of 24-hour survival (adjusted odds ratio [AOR] 4.92; 95%CI 1.51, 16.04, p=0.01), lower odds of shock (AOR 0.28; 95%CI 0.09, 0.85, p=0.03), and lower 24-hour RBC requirement (Coef −3.6 RBC units; 95%CI −7.0, −0.2, p=0.04). Among matched scene patients, PTC RBC was also associated with increased odds of 24-hour survival (AOR 6.31; 95%CI 1.88, 21.14, p<0.01), lower odds of shock (AOR 0.24; 95%CI 0.07, 0.80, p=0.02), and lower 24-hour RBC requirement (Coef −4.5 RBC units; 95%CI −8.3, −0.7, p=0.02). Conclusions PTC RBC was associated with an increased probability of 24-hour survival, decreased risk of shock, and lower 24-hour RBC requirement. PTC RBC appears beneficial in severely injured air medical trauma patients and prospective study is warranted as PTC RBC transfusion becomes more readily available.
Background Older adult trauma patients are at increased risk of poor outcome, both immediately after injury and beyond hospital discharge. Identifying patients early in the hospital stay who are at increased risk of death after discharge can be challenging. Methods Retrospective analysis was performed using our trauma registry linked with the social security death index from 2010–2014. Age was categorized by 18–64 and ≥65 years. We calculated mortality rates by age category then selected elderly patients with mechanism of injury being a fall for further analysis. CT Abbreviated Assessment of Sarcopenia for Trauma (CAAST) was obtained by measuring psoas muscle cross-sectional area adjusted for height and weight. Kaplan-Meier survival analysis was performed and proportional hazards regression modeling was utilized to determine independent risk factors for in-hospital and out-of-hospital mortality. Results 23,622 patients were analyzed (age 18–64: 16,748 and age≥65: 6,874). In-hospital mortality was 1.96% for age 18–64 and 7.19% for age ≥65 (p<0.001); post-discharge 6-month mortality was 1.1% for age 18–64 and 12.86% for age ≥65 (p<0.001). Predictors of in-hospital and post-discharge mortality for age 18–64 and in-hospital mortality for age≥65 group included injury characteristics such as ISS, admission vitals and head injury. Predictors of post-discharge mortality for age ≥65 included skilled nursing prior to admission, disposition, and mechanism of injury being a fall. In total, 57.5% (n=256) of older patients who sustained a fall met criteria for sarcopenia. Sarcopenia was the strongest predictor of out-of-hospital mortality in this cohort with hazard ratio 4.77 (95% CI 2.71–8.40; p<0.001) Conclusion Out of hospital does not assure out of danger for the elderly. Sarcopenia is a strong predictor of 6-month post-discharge mortality for older adults. The CAAST measurement is an efficient and inexpensive measure that can allow clinicians to target older trauma patients at risk of poor outcome for early intervention and/or palliative care services.
Epidemiological study, level III; therapeutic/care management study, level IV.
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