Early Predictors of Transfusion and Mortality After Injury: A Review of the Data-Based Literature
Abstract
Trauma is the leading cause of mortality in the first four decades of life and even though later superseded by heart disease and malignancy, remains a significant cause of death and disability among all age groups. In all settings, hemorrhage is one of the most substantial determinants of poor outcomes and death. Though blood transfusion has the obvious benefit of volume restoration and improved oxygen carrying capacity in the injured patient, there are risks and consequences to the use of blood including transfusion reaction, transmission of blood-borne pathogens, and impact on limited supply. In the past several years, evidence has emerged that allogeneic red blood cell transfusion may have significant deleterious immunologic impact upon the injured host. For all of these reasons, there has been a trend to restrict transfusion in non-urgent clinical settings, and, in general, replacement of blood loss is reserved for urgent conditions in which patients exhibit signs and symptoms of class III or class IV hemorrhage, that is, ongoing or imminently life-threatening. Through this same period, knowledge of the cellular mechanisms of shock and the physiologic response to resuscitation has increased greatly and could be anticipated to provide data-based guidance for changes in practice. The purpose of this paper is to review published data sets on early indicators of mortality after trauma and for the need for transfusion and then, based on these data, to evaluate the risk/benefit ratio of contemporary transfusion strategies in these injured patients.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2006
- Accession Number
- ADA627945
Entities
People
- Brian J. Eastridge
- Debra Malone
- John B Holcomb
Organizations
- United States Army Institute of Surgical Research