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Journal of the Korean Society of Traumatology 2009;22(2):218-226.
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
Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. sohak@catholic.ac.kr
응급실에 내원한 둔상환자의 수혈 필요성 예측인자
오지선ㆍ김형민ㆍ최세민ㆍ최경호ㆍ홍태용ㆍ박규남ㆍ소병학
가톨릭대학교 의과대학 응급의학교실
Abstract
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.
Key Words: Wounds; Nonpenetrating; Blood transfusion; Multiple trauma


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