The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyCrystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way.
Massive transfusion (MT) protocols have emphasized the importance of ratio-based transfusion of plasma and platelets relative to packed red blood cells (PRBCs); however, the risks attributable to crystalloid resuscitation in patients requiring MT remain largely unexplored. We hypothesized that an increased crystalloid:PRBC (C:PRBC) ratio would be associated with increased morbidity and poor outcome after MT. ⋯ In patients requiring MT, crystalloid resuscitation in a ratio greater than 1.5:1 per unit of PRBCs transfused was independently associated with a higher risk of MOF, ARDS, and ACS. These results suggest overly aggressive crystalloid resuscitation should be minimized in these severely injured patients. Further research is required to determine whether incorporation of the C:PRBC ratio into MT protocols improves outcome.
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyEpidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.
Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. ⋯ 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.