응급실에 내원한 둔상환자의 수혈 필요성 예측인자 (Predictive Factors of Blood Transfusion Requirement in Blunt Trauma Patients Admitted to the Emergency Room)

서지정보

· 발행기관 : 대한외상학회
· 수록지 정보 : 대한외상학회지 / 22권 / 2호 / 218 ~ 226페이지
· 저자명 : 오지선, 김형민, 최세민, 최경호, 홍태용, 박규남, 소병학

초록

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative
management. The blood products must be expedited and efficiently to patients in impending shock caused
by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically,
based on the clinician’s and has not been guided by objective parameters, but own opinion, that may
result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome.
This article presents quickly assessable predictive factors for determining if a blood transfusion is required to
improve outcomes in multiple blunt trauma patients admitted to the emergency room.
Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center
by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion
were subjected to univariate and multivariate logistic regression analysis.
Results: Of blunt trauma patients ,9.2% (26/282), received red blood cells in the first 24 hours of care.
Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100
beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score
(RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine
lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR >
100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors.
Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL,
mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR >
100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion
in blunt trauma patients visiting the emergency room.

영어초록

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative
management. The blood products must be expedited and efficiently to patients in impending shock caused
by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically,
based on the clinician’s and has not been guided by objective parameters, but own opinion, that may
result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome.
This article presents quickly assessable predictive factors for determining if a blood transfusion is required to
improve outcomes in multiple blunt trauma patients admitted to the emergency room.
Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center
by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion
were subjected to univariate and multivariate logistic regression analysis.
Results: Of blunt trauma patients ,9.2% (26/282), received red blood cells in the first 24 hours of care.
Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100
beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score
(RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine
lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR >
100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors.
Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL,
mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR >
100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion
in blunt trauma patients visiting the emergency room.

참고자료

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