Admission hematocrit and transfusion requirements after trauma

Chad M. Thorson, Robert M. Van Haren, Mark L. Ryan, Reginald Pereira, Jeremy Olloqui, Gerardo A. Guarch, Jose M. Barrera, Alexander M. Busko, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: The decision to transfuse packed RBCs (PRBC) during initial resuscitation of trauma patients is based on physiologic state, evidence for blood loss, and potential for ongoing hemorrhage. Initial hematocrit (Hct) is not considered an accurate marker of blood loss. This study tests the hypothesis that admission Hct is associated with transfusion requirements after trauma. Methods: From June to December 2008, data from 1,492 consecutive admissions at a Level I trauma center were retrospectively reviewed to determine whether initial Hct was associated with PRBC transfusions. From October 2009 through October 2011, data from 463 consecutive transfused patients were retrospectively reviewed to determine whether Hct correlated with number of PRBC units received. Results: Packed RBC transfusion was not correlated with heart rate and was more highly correlated with Hct (r = -0.45) than with systolic blood pressure or base deficit (r = -0.32 or r = -0.26). Hematocrit was a better overall predictor than systolic blood pressure (sensitivity 45% vs 29%, specificity 94% vs 98%, area under receiver operator characteristic curve 0.71 vs 0.64). Lower Hct was associated with hypotension, more advanced shock, higher blood loss, and increased transfusion of PRBC, plasma, platelets, or cryoprecipitate (all, p < 0.01). Conclusion: Admission Hct is more strongly associated with the PRBC transfusion than either tachycardia, hypotension, or acidosis. Admission Hct is also correlated with 24-hour blood product requirements in those receiving early transfusions. These findings challenge current thinking and suggest that fluid shifts are rapid after trauma and that Hct can be important in initial trauma assessment.

Original languageEnglish
Pages (from-to)65-73
Number of pages9
JournalJournal of the American College of Surgeons
Volume216
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Hematocrit
Wounds and Injuries
Blood Pressure
Hypotension
Fluid Shifts
Trauma Centers
Acidosis
Tachycardia
Resuscitation
Shock
Blood Platelets
Heart Rate
Hemorrhage

Keywords

  • base deficit
  • BD
  • Hb
  • Hct
  • heart rate
  • hematocrit
  • hemoglobin
  • HR
  • odds ratio
  • OR
  • packed RBCs
  • PRBC
  • SBP
  • systolic blood pressure

ASJC Scopus subject areas

  • Surgery

Cite this

Admission hematocrit and transfusion requirements after trauma. / Thorson, Chad M.; Van Haren, Robert M.; Ryan, Mark L.; Pereira, Reginald; Olloqui, Jeremy; Guarch, Gerardo A.; Barrera, Jose M.; Busko, Alexander M.; Livingstone, Alan; Proctor, Kenneth G.

In: Journal of the American College of Surgeons, Vol. 216, No. 1, 01.01.2013, p. 65-73.

Research output: Contribution to journalArticle

Thorson, CM, Van Haren, RM, Ryan, ML, Pereira, R, Olloqui, J, Guarch, GA, Barrera, JM, Busko, AM, Livingstone, A & Proctor, KG 2013, 'Admission hematocrit and transfusion requirements after trauma', Journal of the American College of Surgeons, vol. 216, no. 1, pp. 65-73. https://doi.org/10.1016/j.jamcollsurg.2012.09.011
Thorson CM, Van Haren RM, Ryan ML, Pereira R, Olloqui J, Guarch GA et al. Admission hematocrit and transfusion requirements after trauma. Journal of the American College of Surgeons. 2013 Jan 1;216(1):65-73. https://doi.org/10.1016/j.jamcollsurg.2012.09.011
Thorson, Chad M. ; Van Haren, Robert M. ; Ryan, Mark L. ; Pereira, Reginald ; Olloqui, Jeremy ; Guarch, Gerardo A. ; Barrera, Jose M. ; Busko, Alexander M. ; Livingstone, Alan ; Proctor, Kenneth G. / Admission hematocrit and transfusion requirements after trauma. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 1. pp. 65-73.
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AU - Ryan, Mark L.

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AU - Olloqui, Jeremy

AU - Guarch, Gerardo A.

AU - Barrera, Jose M.

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N2 - Background: The decision to transfuse packed RBCs (PRBC) during initial resuscitation of trauma patients is based on physiologic state, evidence for blood loss, and potential for ongoing hemorrhage. Initial hematocrit (Hct) is not considered an accurate marker of blood loss. This study tests the hypothesis that admission Hct is associated with transfusion requirements after trauma. Methods: From June to December 2008, data from 1,492 consecutive admissions at a Level I trauma center were retrospectively reviewed to determine whether initial Hct was associated with PRBC transfusions. From October 2009 through October 2011, data from 463 consecutive transfused patients were retrospectively reviewed to determine whether Hct correlated with number of PRBC units received. Results: Packed RBC transfusion was not correlated with heart rate and was more highly correlated with Hct (r = -0.45) than with systolic blood pressure or base deficit (r = -0.32 or r = -0.26). Hematocrit was a better overall predictor than systolic blood pressure (sensitivity 45% vs 29%, specificity 94% vs 98%, area under receiver operator characteristic curve 0.71 vs 0.64). Lower Hct was associated with hypotension, more advanced shock, higher blood loss, and increased transfusion of PRBC, plasma, platelets, or cryoprecipitate (all, p < 0.01). Conclusion: Admission Hct is more strongly associated with the PRBC transfusion than either tachycardia, hypotension, or acidosis. Admission Hct is also correlated with 24-hour blood product requirements in those receiving early transfusions. These findings challenge current thinking and suggest that fluid shifts are rapid after trauma and that Hct can be important in initial trauma assessment.

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KW - odds ratio

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KW - SBP

KW - systolic blood pressure

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