E. W. Baird1, D. T. Lammers1, L. Nguyen1, R. Griffin1, J. Jansen1, J. B. Holcomb1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Resuscitation strategies for severely injured patients involves early identification and rapid transfusion of blood products. The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial found that balanced transfusion provided the optimal outcomes; however, it remains unclear if this association holds for different mechanisms of injury. We performed a secondary analysis of the PROPPR trial to assess for differences between blunt and penetrating injury patterns based on their resuscitation strategies.
Methods: In this secondary analysis of data from the PROPPR trial, we compared a balanced transfusion strategy (1:1:1) versus (1:1:2) in seriously injured patients and stratified patients based on blunt verse penetrating mechanism of injury. Multivariable logistic regression models were performed to assess for differences in outcomes based on resuscitation strategy. Primary outcomes included mortality at various time points within the first 24-hours and at 30 days.
Results: A total of 648 patients were included in the analysis. The mean age was 34.5 years, 46.6% sustained a penetrating injury, the mean Injury Severity Score was 28.7. Overall mortality for all injuries was 23.0%, with a mortality of 16.5% for blunt (n=107) and 6.7% (n=42) for penetrating injuries. Overall, 49.7% of patients received balanced transfusions. A balanced transfusion strategy in blunt injury patients demonstrated a decreased mortality at 3-hours (OR 0.35, 95% CI 0.18-0.71; p=0.003), however failed to demonstrate a significant mortality benefit at all other times assessed for both blunt and penetrating injuries (Table 1).
Conclusion: This secondary analysis of the PROPPR trial demonstrates that patients in hemorrhagic shock who sustained a blunt mechanism of injury had a higher mortality rate than penetrating patients and received the greatest mortality benefit from a balanced transfusion strategy within the first 3 hours from arrival. Future studies assessing optimal resuscitation strategies for varying mechanisms of injury are warranted.
