Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Predictive Factors of Blood Transfusion Requirement in Blunt Trauma Patients Admitted to the Emergency Room

응급실에 내원한 둔상환자의 수혈 필요성 예측인자

  • Oh, Ji Sun (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung Min (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Choi, Se Min (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Choi, Kyoung Ho (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Hong, Tae Yong (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Park, Kyu Nam (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • So, Byung Hak (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea)
  • 오지선 (가톨릭대학교 의과대학 응급의학과교실) ;
  • 김형민 (가톨릭대학교 의과대학 응급의학과교실) ;
  • 최세민 (가톨릭대학교 의과대학 응급의학과교실) ;
  • 최경호 (가톨릭대학교 의과대학 응급의학과교실) ;
  • 홍태용 (가톨릭대학교 의과대학 응급의학과교실) ;
  • 박규남 (가톨릭대학교 의과대학 응급의학과교실) ;
  • 소병학 (가톨릭대학교 의과대학 응급의학과교실)
  • Received : 2009.08.29
  • Accepted : 2009.10.23
  • Published : 2009.12.30
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Abstract

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

Keywords

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