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Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study
Kyungjin Hwang1, Junsik Kwon1, Jayun Cho1
1Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea.
Insights
Implementing a trauma center and massive transfusion protocol (TCMTP) significantly improved survival rates for major trauma patients in a developing country. This highlights the importance of tailored trauma systems for better clinical outcomes.
Area of Science:
- Trauma Care Systems
- Emergency Medicine
- Public Health
Background:
- Evaluating the effectiveness of a trauma center and massive transfusion protocol (TCMTP) in a developing nation.
- Assessing clinical outcomes in a setting lacking a robust, pre-established trauma system.
Purpose of the Study:
- To determine the impact of implementing a TCMTP on patient outcomes.
- To compare clinical results before and after the establishment of the TCMTP.
Main Methods:
- Inclusion of major trauma patients (>15 years, ISS >15) receiving ≥10 units PRBCs within 24 hours.
- Comparison of patient cohorts from pre-TCMTP (2010-2012), interim-TCMTP (2013-2014), and post-TCMTP (2015-2016) periods.
- Analysis of demographics, transfusion strategies, fluid therapy, and survival rates using Kaplan-Meier and Cox regression.
Main Results:
- Significant increases in fresh-frozen plasma/PRBC ratio and crystalloid infusion post-TCMTP.
- A notable reduction in colloid infusion after TCMTP implementation.
- A significant improvement in 90-day survival rates, from 45.3% pre-TCMTP to 75.8% post-TCMTP (p=0.001).
- TCMTP demonstrated a hazard ratio of 0.380 for mortality in Cox regression analysis.
Conclusions:
- Establishing trauma centers and tailored massive transfusion protocols can enhance outcomes for major trauma patients.
- The findings are applicable even in developing countries without comprehensive trauma systems.
- Site-specific adaptation of trauma protocols is crucial for improving patient survival.
Background:
This study evaluated the effectiveness and clinical outcomes of the implementation of a trauma center and massive transfusion protocol (TCMTP) in a developing country without a well-established trauma system.
Methods:
We included patients (1) aged >15 years, (2) with an Injury Severity Score >15, (3) who received ≥10 units of packed red blood cells (PRBCs) within 24 h, (4) who directly visited our institution from 2010 to 2016, and (5) who survived for ≥24 h. Patients treated during the post-TCMTP period (2015-2016) were compared with historical groups treated pre-TCMTP (2010-2012) and interim-TCMTP (2013-2014). Demographics, transfusion and fluid therapy performance, and clinical outcomes were compared between the three groups.
Results:
Overall, 190 patients were included: 64, 64, and 62 patients in the pre-TCMTP, interim-TCMTP, and post-TCMTP groups, respectively. Comparison between the three groups revealed significant differences in the fresh-frozen plasma/PRBC ratio (p = 0.001) and crystalloid infusion (p = 0.007); these variables gradually increased from pre- to post-TCMTP. Conversely, colloid infusion showed a reduction post-TCMTP (p < 0.001). Kaplan-Meier curves revealed that the 90-day survival rate was significantly higher in the post-TCMTP group (pre-TCMTP: 45.3 vs. 75.8%, p = 0.001; interim-TCMTP: 56.3 vs. 75.8%, p = 0.027). In Cox regression hierarchical survival analysis, TCMTP showed a hazard ratio for mortality of 0.380 after adjusting for all potentially confounding factors.
Conclusions:
Our results suggest that building trauma centers and establishing a massive transfusion protocol according to the specific situations of a country will help improve outcomes for major trauma patients, even in developing countries without a well-established trauma system.
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