The new metric to define large-volume hemorrhage: results of a prospective study of the critical administration threshold

The Journal of Trauma and Acute Care Surgery
Stephanie A SavageTimothy C Fabian

Abstract

Definitions of massive transfusion (MT), 10 or more units of packed red blood cells (PRBCs) in 24 hours, focus on static volumes over fixed times. This arbitrary volume definition promotes survivor bias and fails to identify the "massively" transfused patient. In previous work, the critical administration threshold (CAT) was created to incorporate both rate and volume of transfusion. CAT proved a superior predictor of mortality compared with traditional MT. The purpose of this study was to prospectively validate CAT in a larger trauma population. Patients receiving at least 1 U of PRBCs within the first day of admission were identified prospectively. Administration time of each unit of PRBCs was recorded in minutes. CAT status, defined as receipt of at least 3 U of blood in a 60-minute period, was identified for the first 24 hours. CAT+ patients were quantified by the number of times CAT+ was reached, that is, once (CAT1), twice (CAT2), three times (CAT3), or 4 or more times (CAT4). A multivariable Cox proportional hazard model with a time-varying covariate was used to quantify a patient's risk of death with increasing CAT status. A total of 316 met inclusion criteria, 161 of whom were CAT+. Seventy-six percent were male, mean ...Continue Reading

References

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Jan 29, 2013·The Journal of Trauma and Acute Care Surgery·Stephanie A SavageTimothy C Fabian

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Citations

Mar 2, 2017·The Journal of Trauma and Acute Care Surgery·Stephanie A SavageTimothy H Pohlman
May 2, 2018·Vox Sanguinis·R A MetcalfM I Montenovo
Dec 1, 2017·The Journal of Trauma and Acute Care Surgery·Michelle H ScerboBryan A Cotton
Feb 21, 2018·The Journal of Trauma and Acute Care Surgery·Christopher Kalhagen BjerkvigGeir Strandenes
Aug 28, 2019·The Journal of Trauma and Acute Care Surgery·Andrew W ShihErik Vu
Dec 5, 2017·The Journal of Trauma and Acute Care Surgery·E I HodgmanUNKNOWN PROMMTT Study Group
Mar 3, 2020·The Journal of Trauma and Acute Care Surgery·Edward S SimUNKNOWN PAMPer study group
May 26, 2017·The Journal of Trauma and Acute Care Surgery·Matthew C HernandezScott P Zietlow
Nov 7, 2019·The Journal of Trauma and Acute Care Surgery·Vincent P AntoUNKNOWN And The PAMPer study group
Dec 15, 2017·Transfusion·John R HessRyan A Metcalf
Sep 21, 2017·The Journal of Trauma and Acute Care Surgery·Stephanie A SavageAli C Martin
Dec 4, 2020·Expert Review of Hematology·Lena M Napolitano
Mar 7, 2020·Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses·Darcy L DayKaren Ng
Apr 20, 2021·Research and Practice in Thrombosis and Haemostasis·Michael J FerraraMyung S Park
May 1, 2021·Nature Reviews. Disease Primers·Ernest E MooreAngela Sauaia
Jun 10, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Lauren SutherlandBrigid C Flynn
Jul 17, 2021·Transfusion·Maxwell A BravermanDonald H Jenkins

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