老年创伤伴或不伴创伤性脑损伤的输血无效阈值。

IF 0.9 4区医学 Q4 CRITICAL CARE MEDICINE

Journal of Trauma Nursing Pub Date : 2025-09-29 DOI:10.1097/JTN.0000000000000888

Nikita Nunes, Hazem Nasef, Samuel Baum, Brian Chin, Quratualin Amin, Heli Patel, Tracy Zito, Adel Elkbuli

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引用次数: 0

摘要

背景：老年创伤患者经常需要大量输血，但关于输血无效阈值（TFTs）的明确指南仍不发达，特别是胸腹损伤和伴发创伤性脑损伤（TBI）患者。目的：探讨老年外伤患者伴或不伴TBI的中重度胸部和/或腹部损伤的TFT。方法：对2017年至2021年美国外科医师学会创伤质量改善计划（ACS-TQIP）数据库进行回顾性队列分析，调查了伴有或不伴有TBI的中重度腹部（简易损伤评分[AIS]腹部≥2）和/或胸部（AIS胸部≥2）损伤的老年创伤患者（年龄≥65岁）。结果包括死亡率、输血阈值、无通气天数、并发症和重症监护病房住院时间（ICU-LOS）。结果：1072例非TBI患者和289例TBI患者纳入本分析。到达后4小时内，非脑外伤患者的TFT为12单位红细胞（红细胞），脑外伤患者的TFT为6单位红细胞。两组患者超过TFT的48小时死亡率均显著增高（OR: 3.949, 95% CI: [2.270, 6.870], p < 0.001; OR: 6.426, 95% CI: [1.772, 23.311], p = 0.005）。超过TFT的非tbi患者发生急性肾损伤（AKI）（OR: 2.606, 95% CI: [1.136, 5.980], p = 0.024）、严重脓毒症（OR: 6.146, 95% CI: [1.485, 25.445], p = 0.012）和显著延长ICU-LOS （B: 3.445, 95% CI: [0.903, 5.987], p = 0.008）的几率更高。结论：在伴有或不伴有中重度TBI的腹部和/或胸部损伤的老年创伤患者中，超过TFT的患者48小时死亡率明显更高。此外，超过TFT的非tbi患者发生严重脓毒症和AKI的几率更高。这项研究为建立针对老年人群的大规模输血指南提供了强有力的证据，特别是有或没有创伤性脑损伤的人群。

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Transfusion Futility Thresholds for Geriatric Trauma With or Without Concomitant Traumatic Brain Injury.

Background: Geriatric trauma patients frequently require massive transfusion, yet clear guidelines on transfusion futility thresholds (TFTs) remain underdeveloped, particularly in patients with thoracoabdominal injuries and concomitant traumatic brain injury (TBI).

Objective: To investigate TFT in geriatric trauma patients with moderate-to-severe chest and/or abdominal injuries with or without TBI.

Methods: This retrospective cohort analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from 2017 to 2021 investigated geriatric trauma patients (age ≥65) with moderate-severe abdominal (abbreviated injury score [AIS] abdomen ≥ 2) and/or chest (AIS chest ≥ 2) injuries with or without concomitant TBI. Outcomes included mortality, transfusion threshold, ventilation-free days, complications, and intensive care unit length of stay (ICU-LOS).

Results: There were 1,072 non-TBI and 289 TBI patients included in this analysis. The TFT was 12 units of packed red blood cells (pRBCs) among non-TBI patients and 6 units of pRBCs among TBI patients within 4 hr of arrival. Patients exceeding the TFT in both groups had significantly higher odds of 48-hr mortality (OR: 3.949, 95% CI: [2.270, 6.870], p < .001; OR: 6.426, 95% CI: [1.772, 23.311], p = .005). Non-TBI patients exceeding the TFT had higher odds of developing acute kidney injury (AKI) (OR: 2.606, 95% CI: [1.136, 5.980], p = .024), severe sepsis (OR: 6.146, 95% CI: [1.485, 25.445], p = .012), and a significantly longer ICU-LOS (B: 3.445, 95% CI: [0.903, 5.987], p = .008).

Conclusion: Among geriatric trauma patients with abdominal and/or chest injuries with or without concomitant moderate-severe TBI, those exceeding the TFT had significantly higher odds of 48-hr mortality. Additionally, non-TBI patients exceeding the TFT had higher odds of severe sepsis and AKI. This study offers strong evidence for the establishment of massive transfusion guidelines specific to the geriatric population, particularly with or without TBI.

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来源期刊

Journal of Trauma Nursing CRITICAL CARE MEDICINENURSING&-NURSING

CiteScore

1.20

自引率

10.00%

发文量

106

期刊介绍： Journal of Trauma Nursing (JTN) is the official journal of the Society of Trauma Nurses. The Society of Trauma Nurses believes that trauma is a disease impacting patients through the continuum of care. The mission of STN is to ensure optimal trauma care through education, collaboration, leadership and membership engagement. As the official publication of the Society of Trauma Nurses, the Journal of Trauma Nursing supports the STN’s strategic goals of effective communication, education and patient advocacy with original, peer-reviewed, research and evidence-based articles and information that reflect the highest standard of collaborative care for trauma patients. The Journal of Trauma Nursing, through a commitment to editorial excellence, implements STN’s vision to improve practice and patient outcomes and to become the premiere global nursing organization across the trauma continuum.