The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: Comparative effectiveness of a time-varying treatment with competing risks
John B. Holcomb,Deborah J. del Junco,Erin E. Fox,Charles E. Wade,Mitchell J. Cohen,Martin A. Schreiber,Louis H. Alarcon,Yu Bai,Karen J. Brasel,Eileen M. Bulger,Bryan A. Cotton,Nena Matijevic,Peter Muskat,John G. Myers,Herb A. Phelan,Christopher E. White,Jiajie Zhang,Mohammad H. Rahbar +17 more
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TLDR
Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission, and among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or Platelet ratios.Abstract:
Objective To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios. Design Prospective cohort study documenting the timing of transfusions during active resuscitation and patient outcomes. Data were analyzed using time-dependent proportional hazards models. Setting Ten US level I trauma centers. Patients Adult trauma patients surviving for 30 minutes after admission who received a transfusion of at least 1 unit of RBCs within 6 hours of admission (n = 1245, the original study group) and at least 3 total units (of RBCs, plasma, or platelets) within 24 hours (n = 905, the analysis group). Main Outcome Measure In-hospital mortality. Results Plasma:RBC and platelet:RBC ratios were not constant during the first 24 hours (P Conclusions Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission. Among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or platelet ratios.read more
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Syndecan-1: A Quantitative Marker for the Endotheliopathy of Trauma.
Erika Gonzalez Rodriguez,Sisse R. Ostrowski,Jessica C. Cardenas,Lisa A. Baer,Jeffrey S. Tomasek,Hanne H. Henriksen,Hanne H. Henriksen,Jakob Stensballe,Bryan A. Cotton,John B. Holcomb,Pär I. Johansson,Pär I. Johansson,Charles E. Wade +12 more
TL;DR: A syndecan-1 level ≥40 ng/mL identified patients with significantly worse outcomes, despite admission physiology similar to those without the condition, despite the condition being known to cause endothelial dysfunction.
Journal ArticleDOI
Resuscitate early with plasma and platelets or balance blood products gradually: findings from the PROMMTT study.
Deborah J. Del Junco,John B. Holcomb,Erin E. Fox,Karen J. Brasel,Herbert Phelan,Eileen M. Bulger,Martin A. Schreiber,Peter Muskat,Louis H. Alarcon,Mitchell J. Cohen,Bryan A. Cotton,Charles E. Wade,John G. Myers,Mohammad H. Rahbar +13 more
TL;DR: Plasma transfusion early in resuscitation had a protective association with mortality, whereas delayed but gradually balanced transfusion ratios did not; further research will require considerably larger numbers of patients receiving platelets early.
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Earlier Endpoints are Required for Hemorrhagic Shock Trials Among Severely Injured Patients
TL;DR: This project determined the optimal endpoint for hemorrhage control trials using existing literature and new analyses of previously published data, including being congruent with the median time to hemorrhagic death, biologic plausibility, and enabling the use of all-cause mortality, which is definitive and objective.
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Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial.
Jessica C. Cardenas,Xu Zhang,Erin E. Fox,Bryan A. Cotton,John R. Hess,Martin A. Schreiber,Charles E. Wade,John B. Holcomb +7 more
TL;DR: Early platelet administration is associated with improved hemostasis and reduced mortality in severely injured, bleeding patients and this work analyzed PROPPR trial patients who received only the first cooler of blood products, which either did or did not contain platelets.
Journal ArticleDOI
Angiographic embolization for hemorrhage following pelvic fracture: Is it "time" for a paradigm shift?
Ronald Tesoriero,Brandon R. Bruns,Mayur Narayan,Joseph J. DuBose,Joseph J. DuBose,Sundeep Guliani,Megan Brenner,Sharon Boswell,Deborah M. Stein,Thomas M. Scalea +9 more
TL;DR: Earlier intervention by Acute Care Surgeons with techniques like preperitoneal packing, aortic balloon occlusion, and use of hybrid operative suites may improve outcomes in Pelvic fracture hemorrhage.
References
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The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies
Erik von Elm,Douglas G. Altman,Matthias Egger,Matthias Egger,Stuart J. Pocock,Peter C Gøtzsche,Jan P. Vandenbroucke +6 more
TL;DR: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study, resulting in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.
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Erik von Elm,Douglas G. Altman,Matthias Egger,Matthias Egger,Stuart J. Pocock,Peter C Gøtzsche,Jan P. Vandenbroucke +6 more
TL;DR: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study, resulting in a checklist of 22 items that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.
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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies
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