Early plasma transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage
| Autor: | Duncan Sloan, Ryan S. Kitagawa, Lindley E. Folkerson, Ronald Chang, Charles E. Wade, John B. Holcomb, H. Alex Choi, Jeffrey S. Tomasek |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Resuscitation Subarachnoid hemorrhage Traumatic brain injury Blood Component Transfusion Subgroup analysis Risk Assessment Article Cohort Studies Plasma 03 medical and health sciences Injury Severity Score 0302 clinical medicine Hematoma Epidural hematoma Trauma Centers Brain Injuries Traumatic medicine Humans Glasgow Coma Scale Hospital Mortality Registries Retrospective Studies business.industry Anticoagulants 030208 emergency & critical care medicine Odds ratio Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Confidence interval Anesthesia Female Surgery business Intracranial Hemorrhages 030217 neurology & neurosurgery |
| Zdroj: | Surgery. 161:538-545 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2016.08.023 |
| Popis: | Background Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large-animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury. However, the choice of initial resuscitation fluid, including the role of plasma, is unclear for patients after isolated traumatic brain injury. Methods We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated traumatic brain injury. “Early plasma” was defined as transfusion of plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early plasma and inhospital survival. After testing for interaction, subgroup analysis was performed based on the pattern of brain injury on initial head computed tomography: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage. Results Of the 633 isolated traumatic brain injury patients included, 178 (28%) who received early plasma were injured more severely coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early plasma versus no early plasma groups (78% vs 84%, P = .08). After adjustment for covariates, early plasma was not associated with improved survival (odds ratio 1.18, 95% confidence interval 0.71–1.96). On subgroup analysis, multifocal intracranial hemorrhage was the largest subgroup with 242 patients. Of these, 61 (25%) received plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early plasma was associated with improved survival (odds ratio 3.34, 95% confidence interval 1.20–9.35). Conclusion Although early plasma transfusion was not associated with improved in-hospital survival for all isolated traumatic brain injury patients, early plasma was associated with increased in-hospital survival in those with multifocal intracranial hemorrhage. |
| Databáze: | OpenAIRE |
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