M Bawazeer1, N Ahmed2, H Izadi3, A McFarlan4, A Nathens5, K Pavenski6. 1. Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada. Electronic address: masbawazeer@hotmail.com. 2. Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada. Electronic address: ahmedn@smh.ca. 3. Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada. Electronic address: hamid.izadi@mail.utoronto.ca. 4. Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada. Electronic address: McFarlanA@smh.ca. 5. Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada. Electronic address: Avery.Nathens@sunnybrook.ca. 6. Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada. Electronic address: pavenskik@smh.ca.
Abstract
BACKGROUND: About 5% of civilian trauma requires massive transfusion. Protocolized resuscitation with blood products to achieve high plasma:RBC ratio has been advocated to improve survival. Our objectives were to measure compliance to our institutional MTP, to identify quality assurance activities that could improve protocol compliance and to determine if protocol compliance was related to patient outcome. METHODS: The investigators determined 13 compliance criteria based upon our institutional protocol. We measured compliance in 72 consecutive MTP activations between January 2010 and September 2011 at a Level I trauma centre. Data elements were retrospectively retrieved from blood bank, trauma registry and clinical records. Patients were stratified into three groups based on compliance level, and mortality differences were compared. RESULTS: Average compliance for the cohort (n=72) was 66%. The most common cause of non-compliance was failure to send a complete haemorrhage panel from the trauma bay (96%). Failure to monitoring blood work every 30min occurred in 89% of cases. Delay in activation and deactivation occurred in 50% and 50% respectively. Non-compliance to protocol-based administration of blood products happened in 47%. The cohort was stratified into three groups based on compliance, A: <60%, B: 60-80% and C: >80% (low, moderate and high compliance groups). There was no statistical significance with regard to median age, median ISS, ED SBP, ED GCS and AIS of the head/spine, chest and abdomen. The mortality rates in each group were 62%, 50% and 10% in the low, moderate and high compliance groups respectively. Mortality differences were compared using adjusted logistic regression. The OR for mortality between Groups A and B=1.1 [95% CI 0.258-4.687 (P=0.899)] while the OR for mortality between Groups C and B=0.02 [95% CI <0.001-0.855 (P=0.041)]. CONCLUSIONS: Measures should be directed towards provider and system factors to improve compliance. In this study, there was an association between survival and higher level of compliance.
BACKGROUND: About 5% of civilian trauma requires massive transfusion. Protocolized resuscitation with blood products to achieve high plasma:RBC ratio has been advocated to improve survival. Our objectives were to measure compliance to our institutional MTP, to identify quality assurance activities that could improve protocol compliance and to determine if protocol compliance was related to patient outcome. METHODS: The investigators determined 13 compliance criteria based upon our institutional protocol. We measured compliance in 72 consecutive MTP activations between January 2010 and September 2011 at a Level I trauma centre. Data elements were retrospectively retrieved from blood bank, trauma registry and clinical records. Patients were stratified into three groups based on compliance level, and mortality differences were compared. RESULTS: Average compliance for the cohort (n=72) was 66%. The most common cause of non-compliance was failure to send a complete haemorrhage panel from the trauma bay (96%). Failure to monitoring blood work every 30min occurred in 89% of cases. Delay in activation and deactivation occurred in 50% and 50% respectively. Non-compliance to protocol-based administration of blood products happened in 47%. The cohort was stratified into three groups based on compliance, A: <60%, B: 60-80% and C: >80% (low, moderate and high compliance groups). There was no statistical significance with regard to median age, median ISS, ED SBP, ED GCS and AIS of the head/spine, chest and abdomen. The mortality rates in each group were 62%, 50% and 10% in the low, moderate and high compliance groups respectively. Mortality differences were compared using adjusted logistic regression. The OR for mortality between Groups A and B=1.1 [95% CI 0.258-4.687 (P=0.899)] while the OR for mortality between Groups C and B=0.02 [95% CI <0.001-0.855 (P=0.041)]. CONCLUSIONS: Measures should be directed towards provider and system factors to improve compliance. In this study, there was an association between survival and higher level of compliance.
Authors: Jeannie L Callum; Calvin H Yeh; Andrew Petrosoniak; Mark J McVey; Stephanie Cope; Troy Thompson; Victoria Chin; Keyvan Karkouti; Avery B Nathens; Kimmo Murto; Suzanne Beno; Jacob Pendergrast; Andrew McDonald; Russell MacDonald; Neill K J Adhikari; Asim Alam; Donald Arnold; Lee Barratt; Andrew Beckett; Sue Brenneman; Hina Razzaq Chaudhry; Allison Collins; Margaret Harvey; Jacinthe Lampron; Clarita Margarido; Amanda McFarlan; Barto Nascimento; Wendy Owens; Menaka Pai; Sandro Rizoli; Theodora Ruijs; Robert Skeate; Teresa Skelton; Michelle Sholzberg; Kelly Syer; Jami-Lynn Viveiros; Josee Theriault; Alan Tinmouth; Rardi Van Heest; Susan White; Michelle Zeller; Katerina Pavenski Journal: CMAJ Open Date: 2019-09-03
Authors: Zachary A Matthay; Zane J Hellmann; Rachael A Callcut; Ellicott C Matthay; Brenda Nunez-Garcia; William Duong; Jeffry Nahmias; Aimee K LaRiccia; M Chance Spalding; Satya S Dalavayi; Jessica K Reynolds; Heather Lesch; Yee M Wong; Amanda M Chipman; Rosemary A Kozar; Liz Penaloza; Kaushik Mukherjee; Khaled Taghlabi; Christopher A Guidry; Sirivan S Seng; Asanthi Ratnasekera; Amirreza Motameni; Pascal Udekwu; Kathleen Madden; Sarah A Moore; Jordan Kirsch; Jesse Goddard; James Haan; Kelly Lightwine; Julianne B Ontengco; Daniel C Cullinane; Sarabeth A Spitzer; John C Kubasiak; Joshua Gish; Joshua P Hazelton; Alexandria Z Byskosh; Joseph A Posluszny; Erin E Ross; John J Park; Brittany Robinson; Mary Kathryn Abel; Alexander T Fields; Jonathan H Esensten; Ashok Nambiar; Joanne Moore; Claire Hardman; Pranaya Terse; Xian Luo-Owen; Anquonette Stiles; Brenden Pearce; Kimberly Tann; Khaled Abdul Jawad; Gabriel Ruiz; Lucy Z Kornblith Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.697
Authors: Roshan Givergis; Swapna Munnangi; Katayoun Fayaz M Fomani; Anthony Boutin; Luis Carlos Zapata; Ld George Angus Journal: Chin J Traumatol Date: 2018-04-18