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9 "Transfusion"
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Original Articles
Clinical characteristics and mortality risk factors among trauma patients by age groups at a single center in Korea over 7 years: a retrospective study
Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Seheon Kim, Hong Rye Kim
J Trauma Inj. 2023;36(4):329-336.   Published online November 7, 2023
DOI: https://doi.org/10.20408/jti.2023.0035
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AbstractAbstract PDF
Purpose
In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality.
Methods
Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18–64 years), group B (65–79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death.
Results
The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death.
Conclusions
For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.
Summary
Effects of Massive Transfusion Protocol Implementation in Trauma Patients at a Level I Trauma Center
Hyun Woo Sun, Sang Bong Lee, Sung Jin Park, Chan Ik Park, Jae Hun Kim
J Trauma Inj. 2020;33(2):74-80.   Published online June 30, 2020
DOI: https://doi.org/10.20408/jti.2020.022
  • 5,658 View
  • 164 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

This study was conducted to investigate whether rapid and efficient administration of blood products was achieved and whether clinical outcomes were improved by applying a massive transfusion protocol (MTP).

Methods

From January 2016 to September 2019, the medical records of trauma patients who received at least 10 units of packed red blood cells (PRBC) at Pusan National University Hospital (level I trauma center) were retrospectively reviewed. The patients treated from January 2016 to January 2018 were designated as the non-MTP group, and those treated from February 2018 to September 2019 were designated as the MTP group.

Results

During the study period, 370 patients received massive transfusions. The non-MTP and MTP groups comprised 84 and 55 patients, respectively. No significant between-group differences were found in the units of PRBC (23.2 vs. 25.3, respectively; p=0.46), fresh frozen plasma (FFP) (21.1 vs. 24.4, respectively; p=0.40), and platelets (PLT) (15.4 vs. 17.0, respectively; p=0.54) administered in the first 24 hours. No statistically significant differences between the non-MTP and MTP groups were found in the FFP-to-PRBC ratio (0.9 vs. 0.94, respectively; p=0.44) and or the PLT-to-PRBC ratio (0.72 vs. 0.72, respectively; p=0.21). However, the total number of cryoprecipitate units was significantly higher in the MTP group than in the non-MTP group (7.4 vs. 15.3 units, respectively; p=0.003) and the ratio of cryoprecipitate to PRBC in the MTP group was significantly higher than in the non-MTP group (0.31 vs. 0.62, respectively; p=0.021). The time to transfusion was significantly reduced after MTP implementation (41.0 vs. 14.9 minutes, respectively; p=0.003).

Conclusions

Although no significant differences were found in the clinical outcomes of patients who had undergone severe trauma, rapid and balanced transfusion was achieved after implementing the MTP.

Summary

Citations

Citations to this article as recorded by  
  • Acquired Factor XIII Deficiency in Patients with Multiple Trauma
    Michael Hetz, Tareq Juratli, Oliver Tiebel, Moritz Tobias Giesecke, Serafeim Tsitsilonis, Hanns-Christoph Held, Franziska Beyer, Christian Kleber
    Injury.2023; 54(5): 1257.     CrossRef
Case Report
Application of Extracorporeal Membranous Oxygenation in Trauma Patient with Possible Transfusion Related Acute Lung Injury (TRALI)
Dae Sang Lee, Chi Min Park
J Trauma Inj. 2015;28(1):34-38.   Published online March 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.1.34
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  • 5 Download
  • 1 Citations
AbstractAbstract PDF
The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.
Summary

Citations

Citations to this article as recorded by  
  • A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
    Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
    The Korean Journal of Blood Transfusion.2015; 26(3): 309.     CrossRef
Original Articles
Factors for Predicting the Need for an Emergency Blood Transfusion to a Multiple Trauma Patient Using Emergency Room Transfusion Score (ETS)
Hyeon Kyu Jo, Yong Jin Park, Sun Pyo Kim, Seong Jung Kim, Soo Hyung Cho, Nam Soo Cho
J Trauma Inj. 2015;28(1):1-8.   Published online March 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.1.1
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AbstractAbstract PDF
PURPOSE
The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS).
METHODS
This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed.
RESULTS
Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas received an emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died.
CONCLUSION
During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture.
Summary
The Relationship between Blood Transfusion and Mortality in Trauma Patients
Se Young Choi, Jun Ho Lee, Young Cheol Choi
J Korean Soc Traumatol. 2008;21(2):108-114.
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  • 3 Download
AbstractAbstract PDF
PURPOSE
Using a propensity analysis, a recent study reported that blood transfusion might not be an independent predictor of mortality in critically ill patients, which contradicted the RESULTS of earlier studies. This study aims to reveal whether or not blood transfusion is an independent predictor of mortality in trauma patients.
METHODS
A total of three hundred fifty consecutive trauma patients who were admitted to our emergency center from January 2004 to October 2005 and who underwent an arterial blood gas analysis and a venous blood analysis were included in this study. Their medical records were collected prospectively and retrospectively. Using a multivariate logistic analysis, data on the total population and on the propensity-score -matched population were retrospectively analyzed for association with mortality.
RESULTS
Of the three hundred fifty patients, one hundred twenty-nine (36.9%) received a blood transfusion. These patients were older (mean age: 48 vs. 44 years; p=0.019) and had a higher mortality rate (27.9% vs.7.7%; p<0.001). In the total population, the multivariate analysis revealed that the Glasgow coma scale score, the systolic blood pressure, bicarbonate, the need for respiratory support, past medical history of heart disease, the amount of blood transfusion for 24 hours, and hemoglobin were associated with mortality. In thirty-seven pairs of patients matched with a propensity score, potassium, new injury severity score, amount of blood transfusion for 24 hours, and pulse rate were associated with mortality in the multivariate analysis. Therefore, blood transfusion was a significant independent predictor of mortality in trauma patients.
CONCLUSION
Blood transfusion was revealed to be a significant independent predictor of mortality in the total population of trauma patients and in the propensity-score-matched population.
Summary
Predictive Factors for Mortality among Adult Trauma Victims Transfused in an Emergency Department
Kyung Won Lee
J Korean Soc Traumatol. 2012;25(3):79-86.
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AbstractAbstract PDF
PURPOSE
The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department.
METHODS
We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors.
RESULTS
The mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS.
CONCLUSION
When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.
Summary
Predictive Factors of Blood Transfusion Requirement in Blunt Trauma Patients Admitted to the Emergency Room
Ji Sun Oh, Hyung Min Kim, Se Min Choi, Kyoung Ho Choi, Tai Yong Hong, Kyu Nam Park, Byung Hak So
J Korean Soc Traumatol. 2009;22(2):218-226.
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AbstractAbstract PDF
PURPOSE
In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician's and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room.
METHODS
In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis.
RESULTS
Of blunt trauma patients ,9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors.
CONCLUSION
In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.
Summary
Validity of Transfusing Group O+ Unmatched Packed Red Blood Cells in Hemorrhagic Shock Patients
Ji Hwan Lee, Minhong Choa, Junho Cho, Sung Pil Chung
J Korean Soc Traumatol. 2009;22(2):167-171.
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AbstractAbstract PDF
PURPOSE
It is important to begin a transfusion safely and appropriately as soon as possible in a hemorrhagic shock patient. A group O+ unmatched pack red blood cell (universal O+) transfusion may satisfy that requirement. We report our experiences with universal O+ to compare its usefulness for hemorrhagic shock patients with that of a matched pack red blood cell transfusion in the emergency department (ED).
METHODS
This is a retrospective study. Patients who had systolic blood pressure of less than 90 mmHg or a pulse rate of more than 120 beats per minute in the ED were included, and their medical records were reviewed. The collected data were demographic data, vital signs, blood test results, time to transfusion, the amount of transfusion, complications, and diagnoses. We calculated the emergency transfusion score (ETS) based on the patients' medical records.
RESULTS
Two hundred thirty-five patients were included. Forty-eight patients (36 trauma and 12 non-trauma patients) were transfused with a universal O+. These patients had less time to transfusion compared with the cross-matched transfusion groups (35+/-42 versus 170+/-187 minutes, p<0.001). There were no differences in complications between groups (p=0.076). Of the patients who were transfused with universal O+, 94.4% got more than 3 ETS.
CONCLUSION
The universal O+ transfusion, compared with matched pack red blood cell transfusion, should be a useful treatment for ED hemorrhagic shock patient due to its having a shorter time to transfusion without an increase in complications.
Summary
Development of Simple Prediction Method for Injury Severity and Amount of Traumatic Hemorrhage via Analysis of the Correlation between Site of Pelvic Bone Fracture and Amount of Transfusion: Pelvic Bleeding Score
Sang Sik Lee, Byung Kwan Bae, Sang Kyoon Han, Sung Wook Park, Ji Ho Ryu, Jin Woo Jeong, Seok Ran Yeom
J Trauma Inj. 2012;25(4):139-144.
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AbstractAbstract PDF
PURPOSE
Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system.
METHODS
We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS).
RESULTS
From among the 102 patients, 97 patients (M:F=68:29, mean age=46.7+/-16.6 years) were enrolled for analysis. The average ISS of the patients was 16.2+/-7.9, and the average amount of packed RBC transfusion for 24 hr was 3.9+/-4.6 units. The regression equation resulting from the multiple linear regression analysis was 'packed RBC units=1.40x(sacrum fracture)+1.72x(pubis fracture)+1.67x(ilium fracture)+0.36' and was found to be suitable (p=0.005). We simplified the regression equation to 'Pelvic Bleeding Score=sacrum+pubis+ilium.' Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%.
CONCLUSION
We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management.
Summary

J Trauma Inj : Journal of Trauma and Injury