Review of transfusion practices and its outcome in trauma patients at an urban level 1 trauma center in India.

CONTEXT: Implementation of appropriate transfusion strategy in a timely manner is of paramount importance during the initial resuscitation of massively bleeding trauma patients. Assessing transfusion patterns can help in planning, resource allocation, and devising proactive strategies for the management of such patients.

AIMS: To analyze transfusion requirements and its triggers in massively bleeding trauma patients.

SETTINGS AND

DESIGN

Retrospective analysis of the transfusion practices for massively bleeding trauma patients requiring immediate blood transfusion.

METHODS

Clinical and transfusion details were collected from patient and the blood bank records, for massively bleeding trauma patients ≥18 years, and required at least 3 units of red blood cells (RBC's) within 1st h of presentation.

STATISTICAL ANALYSIS USED: Descriptive analysis for transfused blood components was done. Followed by regression analysis to identify predictors for transfusion.

RESULTS

A total of 215 (8.4%) patients, received at least 3 units of RBCs within the 1st h of admission. Component utilization rates were 76% for the RBC, 56% for the random donor platelets (RDP) and 68% for the fresh frozen plasma (FFP) in the first 24 h. The ratio of 1:1:1 for RBC: FFP: RDP was achieved in 81 (37.7%) patients and was associated with improved survival at 24 h. Shock index (SI) was found to be the most significant predictor for RBC, platelets, and cryoprecipitate transfusions, whereas FFP transfusions were largely associated with deranged prothrombin time.

CONCLUSIONS

Maintenance of a ratio of 1:1:1 can improve the early outcome in these patients. SI alone can be used as an important clinical tool for predicting transfusion at the time of preliminary evaluation of the bleeding trauma patients.