Alcohol-positive Multiple Trauma Patients with and Without Blood Transfusion: an Outcome Analysis

Overview

Journal J Trauma Manag Outcomes

Publisher Biomed Central

Specialty Emergency Medicine

Date 2009 Mar 10

PMID 19267914

Authors

Manuel F Struck

Thomas Schmidt

Ralph Stuttmann

Peter Hilbert

Affiliations

Soon will be listed here.

Abstract

Background: Blood transfusion is a common therapy for multiple trauma patients, and is often performed soon after hospital admission. It is unclear whether the need for a blood transfusion in multiply injured patients presenting with a positive blood alcohol concentration (BAC) is associated with increased morbidity/mortality, since their risk behavior differs significantly from patients with a negative BAC. In this study, we evaluated the role of blood transfusion in the treatment of BAC-positive multiple trauma patients.

Patients: In a three-year period, 164 patients at a single trauma center presented with a positive BAC, and 145 met the inclusion criteria for further evaluation and regression analysis. We compared patients who were transfused (n = 76) with those who were not transfused (n = 69).

Results: In both groups, the most common causes of trauma were traffic accidents and falls. Most patients were admitted to the hospital from the scene of the accident (77.2%) and were male (89.0%). Transfused patients had a lower GCS (p </= .001) and her ISS (p </= .001), were more likely to have severe head injuries (p </= .001), tended to have higher BACs (p = .053), had lower hemoglobin levels and prothrombin times in the first 24 hours (p </= .001), had lower lactate levels, had higher rates of intubation (p </= .001) and ICU admission, and had longer ICU stays and artificial ventilation times (p </= .001). Mortality was significantly higher in transfused patients (n = 15 vs. n = 3, p </= .001). Non-survivors were more likely to have severe head injuries; be intubated and ventilated; be older; have higher ISS scores, lactate levels, and numbers of transfusions in the first 24 hours; and have lower GCS scores, hemoglobin measurements, and prothrombin levels. In a binary logistic regression model, only age (p = .009) and ISS (p = .004) independently predicted mortality.

Conclusion: In our single-center study, the BAC of multiple trauma patients and the number of blood transfusions they received did not predict mortality in multiple trauma patients if used as independent predictors. Prospective studies with greater sample sizes should be performed to clarify the role of blood transfusions in the outcome of this sub-population.

References

Rootman D, Mustard R, Kalia V, Ahmed N . Increased incidence of complications in trauma patients cointoxicated with alcohol and other drugs. J Trauma. 2007; 62(3):755-8. DOI: 10.1097/TA.0b013e318031aa7f. View

Fabbri A, Marchesini G, Morselli-Labate A, Rossi F, Cicognani A, Dente M . Blood alcohol concentration and management of road trauma patients in the emergency department. J Trauma. 2001; 50(3):521-8. DOI: 10.1097/00005373-200103000-00018. View

Chen S, Lin F, Chang K . Body region prevalence of injury in alcohol- and non-alcohol-related traffic injuries. J Trauma. 1999; 47(5):881-4. DOI: 10.1097/00005373-199911000-00011. View

Hess J, Zimrin A . Massive blood transfusion for trauma. Curr Opin Hematol. 2005; 12(6):488-92. DOI: 10.1097/01.moh.0000177828.85904.70. View

Fabbri A, Marchesini G, Dente M, Iervese T, Spada M, Vandelli A . A positive blood alcohol concentration is the main predictor of recurrent motor vehicle crash. Ann Emerg Med. 2005; 46(2):161-7. DOI: 10.1016/j.annemergmed.2005.04.002. View

Como J, Dutton R, Scalea T, Edelman B, Hess J . Blood transfusion rates in the care of acute trauma. Transfusion. 2004; 44(6):809-13. DOI: 10.1111/j.1537-2995.2004.03409.x. View

London J, Battistella F . Testing for substance use in trauma patients: are we doing enough?. Arch Surg. 2007; 142(7):633-8. DOI: 10.1001/archsurg.142.7.633. View

Watt K, Purdie D, Roche A, McClure R . The relationship between acute alcohol consumption and consequent injury type. Alcohol Alcohol. 2005; 40(4):263-8. DOI: 10.1093/alcalc/agh164. View

Dunne J, Tracy J, Scalea T, Napolitano L . Lactate and base deficit in trauma: does alcohol or drug use impair their predictive accuracy?. J Trauma. 2005; 58(5):959-66. DOI: 10.1097/01.ta.0000158508.84009.49. View

10.

GERSHMAN H, Steeper J . Rate of clearance of ethanol from the blood of intoxicated patients in the emergency department. J Emerg Med. 1991; 9(5):307-11. DOI: 10.1016/0736-4679(91)90371-l. View

11.

Fabbri A, Marchesini G, Morselli-Labate A, Rossi F, Cicognani A, Dente M . Positive blood alcohol concentration and road accidents. A prospective study in an Italian emergency department. Emerg Med J. 2002; 19(3):210-4. PMC: 1725851. DOI: 10.1136/emj.19.3.210. View

12.

Kim K, Nitz L, Richardson J, Li L . Personal and behavioral predictors of automobile crash and injury severity. Accid Anal Prev. 1995; 27(4):469-81. DOI: 10.1016/0001-4575(95)00001-g. View

13.

Dunne J, Malone D, Tracy J, Napolitano L . Allogenic blood transfusion in the first 24 hours after trauma is associated with increased systemic inflammatory response syndrome (SIRS) and death. Surg Infect (Larchmt). 2005; 5(4):395-404. DOI: 10.1089/sur.2004.5.395. View

14.

Stuke L, Diaz-Arrastia R, Gentilello L, Shafi S . Effect of alcohol on Glasgow Coma Scale in head-injured patients. Ann Surg. 2007; 245(4):651-5. PMC: 1877033. DOI: 10.1097/01.sla.0000250413.41265.d3. View

15.

Dunham C, Watson L, Cooper C . Base deficit level indicating major injury is increased with ethanol. J Emerg Med. 2000; 18(2):165-71. DOI: 10.1016/s0736-4679(99)00188-2. View

16.

Hilbert P, zur Nieden K, Hofmann G, Hoeller I, Koch R, Stuttmann R . New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm. Injury. 2007; 38(5):552-8. DOI: 10.1016/j.injury.2006.12.023. View

17.

Tien H, Nascimento Jr B, Callum J, Rizoli S . An approach to transfusion and hemorrhage in trauma: current perspectives on restrictive transfusion strategies. Can J Surg. 2007; 50(3):202-9. PMC: 2384284. View

18.

Tscherne H, Regel G, Sturm J, Friedl H . [Degree of severity and priorities in multiple injuries]. Chirurg. 1987; 58(10):631-40. View

19.

Dutton R, Lefering R, Lynn M . Database predictors of transfusion and mortality. J Trauma. 2006; 60(6 Suppl):S70-7. DOI: 10.1097/01.ta.0000200856.47545.64. View

20.

Lier H, Kampe S, Schroder S . [Prerequisites of a functional haemostasis. What must be considered at the scene of an accident, in the emergency room and during an operation?]. Anaesthesist. 2006; 56(3):239-51. DOI: 10.1007/s00101-006-1109-1. View