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Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience.

Abstract We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004-2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.
PMID
Related Publications
Authors

Mayor MeshTerms

Clinical Protocols

Quality Improvement

Trauma Centers

Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 28424137
OWN - NLM
STAT- MEDLINE
DA  - 20170420
DCOM- 20170501
LR  - 20170501
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 83
IP  - 4
DP  - 2017 Apr 01
TI  - Improvement of Treatment Outcomes after Implementation of a Massive Transfusion
      Protocol: A Level I Trauma Center Experience.
PG  - 394-398
AB  - We assessed the effectiveness of the implementation of an institutional massive
      transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of
      packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level
      I trauma center database, all trauma admissions (2004-2012) that received massive
      transfusions (&gt;/=10 units PRBCs in the first 24 hours) were reviewed
      retrospectively. Demographic data, transfusion ratios, and outcomes were compared
      before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and
      mechanism of injury were similar between 239 PRE and 208 POST trauma patients
      requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and
      platelet:PRBC increased after MTP implementation. Among survivors, MTP
      implementation shortened hospital length of stay from 31 to 26 days (P = 0.04)
      and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear
      regression identified treatment after (versus before) implementation of MTP as an
      independent predictor of decreased ventilator days after adjusting for age,
      Glasgow Coma Scale, and chest Abbreviated Injury Score (P &lt; 0.0001). Modest
      improvement in ratios likely does not account for all significant improvements in
      outcomes. Implementing a standardized protocol likely impacts automation,
      efficiency, and/or timeliness of product delivery.
FAU - Nunn, Andrew
AU  - Nunn A
FAU - Fischer, Peter
AU  - Fischer P
FAU - Sing, Ronald
AU  - Sing R
FAU - Templin, Megan
AU  - Templin M
FAU - Avery, Michael
AU  - Avery M
FAU - Christmas, A Britton
AU  - Christmas AB
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Abbreviated Injury Scale
MH  - Adult
MH  - Blood Component Transfusion/*standards
MH  - *Clinical Protocols
MH  - Female
MH  - Glasgow Coma Scale
MH  - Hospital Mortality
MH  - Humans
MH  - Length of Stay/statistics &amp; numerical data
MH  - Male
MH  - Outcome and Process Assessment (Health Care)
MH  - *Quality Improvement
MH  - Resuscitation/*standards
MH  - Retrospective Studies
MH  - *Trauma Centers
MH  - Wounds and Injuries/mortality/*therapy
EDAT- 2017/04/21 06:00
MHDA- 2017/05/02 06:00
CRDT- 2017/04/21 06:00
PST - ppublish
SO  - Am Surg. 2017 Apr 1;83(4):394-398.

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