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J Korean Soc Emerg Med > Volume 29(4); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(4): 289-296.
중증 외상에서 critical administration threshold와 대량수혈의 사망예측 비교
조재완1 , 서강석1 , 이미진1 , 박정배1 , 김종근1 , 류현욱1 , 안재윤1 , 문성배1 , 이동언1 , 김윤정1 , 최재영2
1경북대학교 의과대학 응급의학교실
2경북대학교 의과대학 소아과학교실
Validation of critical administration threshold and massive transfusion for mortality prediction in patients with adult severe trauma
Jae Wan Cho1 , Kang Suk Seo1 , Mi Jin Lee1 , Jung Bae Park1 , Jong Kun Kim1 , Hyun Wook Ryoo1 , Jae Yun Ahn1 , Sungbae Moon1 , Dong Eun Lee1 , Yun Jeong Kim1 , Jae Young Choe2
1Departments of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
2Departments of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
Correspondence  Kang Suk Seo ,Tel: 053-200-6400, Fax: 053-428-2820, Email: kssuh@knu.ac.kr,
Received: April 20, 2018; Revised: June 19, 2018   Accepted: July 2, 2018.  Published online: August 31, 2018.
A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT.
Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality.
A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Fortytwo (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040-18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376-8.979).
The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.
Key words: Blood transfusion; Adult; Multiple trauma; Injury Severity Score; Hospital mortality
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