Massive blood transfusions post trauma in the elderly compared to younger patients

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Introduction Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients =65 years old and explore variables associated with poor outcomes. Methods A retrospective review of registry data on all major trauma patients presenting to a level I trauma centre between 2006 and 2011 was conducted. Mortality at hospital discharge among patients =65 years old was compared to the younger cohort. A multivariable logistic regression model was constructed to determine independent risk-factors for mortality among older patients. Results There were 51 (16.4 ) patients of age =65 years who received a massive transfusion. There were 20 (39.2 ) deaths, a proportion significantly higher than 55 (21.1 ) deaths among younger patients (p <0.01). Pre-hospital GCS, the presence of acute traumatic coagulopathy and higher systolic blood pressure on presentation were independently associated with higher mortality. Age and volume of red cells transfused were not significantly associated with higher mortality. Conclusions Survival to hospital discharge was demonstrated in elderly patients receiving massive transfusions post trauma, even in the presence of multiple risk factors for mortality. Restrictive resuscitation or transfusion on the basis of age alone cannot be supported. Early aggressive resuscitation of elderly trauma patients along specific guidelines directed at the geriatric population is justified and may further improve outcomes.
Original languageEnglish
Pages (from-to)1296 - 1300
Number of pages5
JournalInjury
Volume45
Issue number9
DOIs
Publication statusPublished - 2014

Cite this

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title = "Massive blood transfusions post trauma in the elderly compared to younger patients",
abstract = "Introduction Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients =65 years old and explore variables associated with poor outcomes. Methods A retrospective review of registry data on all major trauma patients presenting to a level I trauma centre between 2006 and 2011 was conducted. Mortality at hospital discharge among patients =65 years old was compared to the younger cohort. A multivariable logistic regression model was constructed to determine independent risk-factors for mortality among older patients. Results There were 51 (16.4 ) patients of age =65 years who received a massive transfusion. There were 20 (39.2 ) deaths, a proportion significantly higher than 55 (21.1 ) deaths among younger patients (p <0.01). Pre-hospital GCS, the presence of acute traumatic coagulopathy and higher systolic blood pressure on presentation were independently associated with higher mortality. Age and volume of red cells transfused were not significantly associated with higher mortality. Conclusions Survival to hospital discharge was demonstrated in elderly patients receiving massive transfusions post trauma, even in the presence of multiple risk factors for mortality. Restrictive resuscitation or transfusion on the basis of age alone cannot be supported. Early aggressive resuscitation of elderly trauma patients along specific guidelines directed at the geriatric population is justified and may further improve outcomes.",
author = "Biswadev Mitra and Alexander Olaussen and Peter Cameron and Tom O'Donohoe and Mark Fitzgerald",
year = "2014",
doi = "10.1016/j.injury.2014.01.016",
language = "English",
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pages = "1296 -- 1300",
journal = "Injury",
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Massive blood transfusions post trauma in the elderly compared to younger patients. / Mitra, Biswadev; Olaussen, Alexander; Cameron, Peter; O'Donohoe, Tom; Fitzgerald, Mark.

In: Injury, Vol. 45, No. 9, 2014, p. 1296 - 1300.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Massive blood transfusions post trauma in the elderly compared to younger patients

AU - Mitra, Biswadev

AU - Olaussen, Alexander

AU - Cameron, Peter

AU - O'Donohoe, Tom

AU - Fitzgerald, Mark

PY - 2014

Y1 - 2014

N2 - Introduction Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients =65 years old and explore variables associated with poor outcomes. Methods A retrospective review of registry data on all major trauma patients presenting to a level I trauma centre between 2006 and 2011 was conducted. Mortality at hospital discharge among patients =65 years old was compared to the younger cohort. A multivariable logistic regression model was constructed to determine independent risk-factors for mortality among older patients. Results There were 51 (16.4 ) patients of age =65 years who received a massive transfusion. There were 20 (39.2 ) deaths, a proportion significantly higher than 55 (21.1 ) deaths among younger patients (p <0.01). Pre-hospital GCS, the presence of acute traumatic coagulopathy and higher systolic blood pressure on presentation were independently associated with higher mortality. Age and volume of red cells transfused were not significantly associated with higher mortality. Conclusions Survival to hospital discharge was demonstrated in elderly patients receiving massive transfusions post trauma, even in the presence of multiple risk factors for mortality. Restrictive resuscitation or transfusion on the basis of age alone cannot be supported. Early aggressive resuscitation of elderly trauma patients along specific guidelines directed at the geriatric population is justified and may further improve outcomes.

AB - Introduction Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients =65 years old and explore variables associated with poor outcomes. Methods A retrospective review of registry data on all major trauma patients presenting to a level I trauma centre between 2006 and 2011 was conducted. Mortality at hospital discharge among patients =65 years old was compared to the younger cohort. A multivariable logistic regression model was constructed to determine independent risk-factors for mortality among older patients. Results There were 51 (16.4 ) patients of age =65 years who received a massive transfusion. There were 20 (39.2 ) deaths, a proportion significantly higher than 55 (21.1 ) deaths among younger patients (p <0.01). Pre-hospital GCS, the presence of acute traumatic coagulopathy and higher systolic blood pressure on presentation were independently associated with higher mortality. Age and volume of red cells transfused were not significantly associated with higher mortality. Conclusions Survival to hospital discharge was demonstrated in elderly patients receiving massive transfusions post trauma, even in the presence of multiple risk factors for mortality. Restrictive resuscitation or transfusion on the basis of age alone cannot be supported. Early aggressive resuscitation of elderly trauma patients along specific guidelines directed at the geriatric population is justified and may further improve outcomes.

UR - http://www.sciencedirect.com/science/article/pii/S0020138314000436

U2 - 10.1016/j.injury.2014.01.016

DO - 10.1016/j.injury.2014.01.016

M3 - Article

VL - 45

SP - 1296

EP - 1300

JO - Injury

JF - Injury

SN - 0020-1383

IS - 9

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