Trauma-induced coagulopathy: impact of the early coagulation support protocol on blood product consumption, mortality and costs

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• 作者：Giuseppe Nardi (1)
  Vanessa Agostini (2)
  Beatrice Rondinelli (3)
  Emanuele Russo (4)
  Barbara Bastianini (1)
  Giovanni Bini (4)
  Simona Bulgarelli (2)
  Emiliano Cingolani (1)
  Alessia Donato (5)
  Giorgio Gambale (4)
  Giulia Ranaldi (1)
  
  1. Department of Shock and Trauma Center ; S Camillo-Forlanini Hospital ; Circonvallazione Gianicolense 87 ; Roma ; 00152 ; Italy
  2. Departement of Clinical Pathology and Transfusion Medicine ; Bufalini Hospital ; Via Ghirotti 286 ; Cesena ; 45072 ; Italy
  3. Department of Hematology and Transfusion Medicine ; S Camillo-Forlanini Hospital ; Circonvallazione Gianicolense 87 ; Roma ; 00152 ; Italy
  4. Department of Anesthesia and ICU ; Trauma Service ; Bufalini Hospital ; Via Ghirotti 286 ; Cesena ; 45072 ; Italy
  5. Department of Anesthesia and Intensive Care ; University of Siena ; Strada delle Scotte 14 ; Siena ; 53100 ; Italy
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：1,925 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Hemorrhage is the principal cause of death in the first few hours following severe injury. Coagulopathy is a frequent complication of critical bleeding. A network of Italian trauma centers recently developed a protocol to prevent and treat trauma-induced coagulopathy. A pre-post cohort multicenter study was conducted to assess the impact of the early coagulation support (ECS) protocol on blood products consumption, mortality and treatment costs. Methods We prospectively collected data from all severely injured patients (Injury Severity Score (ISS) >15) admitted to two trauma centers in 2013 and compared these findings with the data for 2011. Patients transfused with at least 3 units of packed red blood cells (PRBCs) within 24聽hours of an accident were included in the study. In 2011, patients with significant hemorrhaging were treated with early administration of plasma with the aim of achieving a high (鈮?:2) plasma-to-PRBC ratio. In 2013, the ECS protocol was the treatment strategy. Outcome data, blood product consumption and treatment costs were compared between the two periods. Results The two groups were well matched for demographics, injury severity (ISS: 32.9 in 2011 versus 33.6 in 2013) and clinical and laboratory data on admission. In 2013, a 40% overall reduction in PRBCs was observed, together with a 65% reduction in plasma and a 52% reduction in platelets. Patients in the ECS group received fewer blood products: 6.51 units of PRBCs versus 8.14 units. Plasma transfusions decreased from 8.98 units to 4.21 units (P P Conclusions The introduction of the ECS protocol in two Italian trauma centers was associated with a marked reduction in blood product consumption, reaching statistical significance for plasma and platelets, and with a non-significant trend toward a reduction in early and 28-day mortality. The overall costs for transfusion and coagulation support (including point-of-care tests) decreased by 23% between 2011 and 2013.