Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario Trauma Program, London Health Sciences Centre Centre for Critical Illness Research Division of Critical Care, London Health Sciences Centre, London, Ontario, Can
This study was undertaken to determine if, amongst civilian trauma patients requiring massive transfusion (MT), the use of a formal trauma transfusion pathway (TTP), in comparison with transfusion without a TTP, is associated with a reduction in mortality, or changes in indices of coagulation, blood product utilisation and complications. A systematic review of three bibliographic databases, reference lists and conference
proceedings was conducted. Studies were included if comparisons were made between patients receiving transfusion with and without a TTP. Data were extracted by two independent reviewers on population characteristics, transfusion strategies, blood product utilisation, indices of coagulation, clinical outcomes and complications. Data were pooled using a random effects model and heterogeneity explored. Seven observational studies met all eligibility criteria. Amongst 1801 patients requiring MT, TTPs were associated with a significant reduction in mortality (RR 0.69, 95% CI 0.55, 0.87). No significant increase in the mean number of PRBC transfused between TTP and control patients was seen (MD -1.17 95% CI -2.70, 0.36). When studies assessing only trauma patients were considered, TTPs were associated with a reduction in the mean number of units of plasma transfused (MD -2.63, 95% CI -4.24, -1.01). In summary, the use of TTPs appears to be associated with a reduction in mortality amongst trauma patients requiring MT without a clinically significant increase in the number of PRBC transfused and a potential reduction in plasma transfusion. Effects of TTPs on platelet transfusion, indices of coagulation and complications remain unclear. A randomised controlled trial is warranted. Copyright 2012 The Authors. Transfusion Medicine Copyright 2012 British Blood Transfusion Society. DO http://dx.doi.org/10.1111/j.1365-3148.2012.01150.x
