Trauma-induced coagulopathy: impact of the early coagulation support protocol on blood product consumption, mortality and costs
| Autor: | Beatrice Maria Rondinelli, Giulia Ranaldi, Alessia Donato, Emanuele Russo, Giuseppe Nardi, Giovanni Bini, Giorgio Gambale, Barbara Bastianini, Emiliano Cingolani, Vanessa Agostini, Simona Bulgarelli |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Resuscitation medicine.medical_specialty Blood Component Transfusion Hemorrhage Critical Care and Intensive Care Medicine Plasma Injury Severity Score Blood product Coagulopathy medicine Humans Hospital Mortality Prospective Studies Prospective cohort study Blood Coagulation Cause of death business.industry Research Blood Coagulation Disorders Middle Aged medicine.disease Survival Analysis Surgery Treatment Outcome Italy Anesthesia Female business Packed red blood cells |
| Zdroj: | Critical Care |
| ISSN: | 1466-609X 1364-8535 |
| Popis: | 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 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 (≥1:2) 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. |
| Databáze: | OpenAIRE |
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