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Journal of Trauma and Injury 2012;25(4):247-253.
Analysis of the Prognostic Factors in Trauma Patients with Massive Bleeding
Seok Ho Choi, Gil Joon Suh, Yeong Cheol Kim, Woon Yong Kwon, Kook Nam Han, Kyoung Hak Lee, Soo Eon Lee, Seung Je Go
1Trauma Center, Seoul National University Hospital, Korea. suhgil@snu.ac.kr
2Department of Surgery, Seoul National University Hospital, Korea.
3Department of Emergency Medicine, Seoul National University Hospital, Korea.
4Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Korea.
5Department of Orthopedic Surgery, Seoul National University Hospital, Korea.
6Department of Neurosurgery, Seoul National University Hospital, Korea.
외상으로 인한 대량 출혈 환자에서의 예후인자 분석
최석호1,2∙서길준1,3∙김영철1,2∙권운용3∙한국남1,4∙이경학1,5∙이수언1,6∙고승제1
서울대학교병원 1중증외상센터, 2외과, 3응급의학과, 4흉부외과, 5정형외과, 6신경외과
Received: 16 November 2012   • Revised: 26 November 2012   • Accepted: 30 November 2012
Abstract
PURPOSE
Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival.
METHODS
This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test.
RESULTS
Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not.
CONCLUSION
The ISS was a prognostic factor for trauma patients with massive bleeding.
Key Words: Trauma; Hemorrhage; Injury severity score; Embolization; Surgery


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