Variations Between Level I Trauma Centers in 24-Hour Mortality in Severely Injured Patients Requiring a Massive Transfusion

• DOI: 10.1097/ta.0b013e318227f307
• Publication Date: 2011-08-03T21:10:15Z
• Authors: Charles E. Wade; Deborah J. del Junco; John B. Holcomb
• Keywords: Trauma Center; Abbreviated Injury Scale; Odds

Background: Significant differences in outcomes have been demonstrated between Level I trauma centers. Usually these are ascribed to regional or administrative differences, although the influence of variation clinical practice is rarely considered. This study was undertaken determine whether early mortality patients receiving a massive transfusion (MT, ≥10 units pf RBCs within 24 hours admission) persist after adjustment for patient and differences. We hypothesized among centers 24-hour could predominantly be accounted by practices as well characteristics. Methods: Data were retrospectively collected over 1-year period from 15 on an MT. A purposeful variable selection strategy used build final multivariable logistic model assess mortality. Adjusted odds ratios each center calculated. Results: There 550 evaluated, but only 443 had complete data set variables included model. Unadjusted varied considerably across centers, ranging 10% 75%. Multivariable regression identified injury severity score (ISS), abbreviated scale (AIS) chest, admission base deficit, heart rate, total RBC transfused, plasma:RBC platelet:RBC associated with After adjusting transfusion, treatment no longer significant. Conclusions: In defined population MT, between-center may practices.