分析创伤患者到达时的血红蛋白与 24 小时内输血过量的关系。

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2024-11-05 DOI:10.1093/milmed/usae293
Nicholas K Lahvic, Steven G Schauer, Sophie S Higgins, Jay A Johannigman, Kurt W Grathwohl
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引用次数: 0

摘要

背景:近年来,出血控制和复苏理念不断发展,导致创伤患者积极使用血液制品。随之而来的是过度输血、不良反应以及不必要输血造成浪费的潜在风险。在未来的大规模作战行动中,保存血液制品的方法尤为重要,因为在这种情况下,供应链可能会出现紧张。本研究探讨了急诊科(ED)到达血红蛋白(HGB)与军事创伤中心重大创伤后 24 小时内幸存者过度输血的关系:我们对发生 "重大创伤 "并接受过任何红细胞的患者进行了一项回顾性队列研究。输血过量的定义是 24 小时内 HGB 水平≥11.0 g/dL(结果变量)。多变量逻辑回归统计用于比较各组,并调整混杂因素(损伤严重程度评分、到达时修正休克指数、损伤类型、年龄和性别)。以 24 小时内输血量过大为结果(二元),以到达时 HGB(连续)为自变量,构建了接收者操作特征:共有 382 名患者符合纳入标准。30.4%的患者(n = 116)发生了过度输血,平均 ED HGB 水平为 13.2 g/dL(12.9 至 13.6)对 11.6 g/dL(11.3 至 11.8,P 结论:我们发现,在平民创伤环境中,到达时的 HGB 值与 24 小时幸存者的过度输血有关。我们的研究结果将为今后调查血液稀释临床实践指南的前瞻性研究提供参考。
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An Analysis of the Association of Arrival Hemoglobin With Overtransfusion at 24 Hours in a Trauma Population.

Background: Hemorrhage control and resuscitative concepts have evolved in recent years, leading to aggressive use of blood products in trauma patients. There is subsequently a potential risk for overtransfusion, adverse effects, and waste associated with unnecessary transfusion. Methods for conserving blood products are of particular importance in future large-scale combat operations where supply chains are likely to be strained. This study examined the association of emergency department (ED) arrival hemoglobin (HGB) with overtransfusion among survivors at 24 hours after major trauma at a military trauma center.

Materials and methods: We performed a retrospective cohort study of patients who had a "major trauma" activation and received any red blood cells. Overtransfusion was defined as a HGB level ≥11.0 g/dL at 24 hours (outcome variable). Multivariable logistic regression statistics were used to compare groups and adjust for confounders (injury severity score, arrival modified shock index, injury type, age, and gender). A receiver operating characteristic was constructed with overtransfusion at 24 hours as the outcome (binary) and arrival HGB (continuous) as the independent variable.

Results: A total of 382 patients met inclusion criteria. Overtransfusion occurred in 30.4% (n = 116) of patients, with mean ED HGB levels of 13.2 g/dL (12.9 to 13.6) versus 11.6 g/dL (11.3 to 11.8, P < .001). Receiver operating characteristic analysis showed that ED HGB was highly sensitive (0.931) for predicting 24-hour overtransfusion. In our multivariable logistic regression analysis, when adjusting for injury severity score, arrival modified shock index, injury type, age, and gender, we found that the ED HGB value had a per-unit odds ratio of 1.60 (95% CI, 1.38 to 1.86) for 24-hour overtransfusion. Hospital and intensive care unit length of stay, mechanical ventilator days, and mortality did not increase.

Conclusion: We found that the arrival HGB value was associated with overtransfusion among 24-hour survivors in a civilian trauma setting. Our findings will inform future prospective studies that investigate blood sparing clinical practice guidelines.

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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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