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Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea

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dc.contributor.authorHwang, K-
dc.contributor.authorKwon, J-
dc.contributor.authorCho, J-
dc.contributor.authorHeo, Y-
dc.contributor.authorLee, JC-
dc.contributor.authorJung, K-
dc.date.accessioned2019-11-13T04:26:51Z-
dc.date.available2019-11-13T04:26:51Z-
dc.date.issued2018-
dc.identifier.issn0364-2313-
dc.identifier.urihttp://repository.ajou.ac.kr/handle/201003/17500-
dc.description.abstractBACKGROUND: 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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dc.language.isoen-
dc.subject.MESHAdolescent-
dc.subject.MESHAdult-
dc.subject.MESHAged-
dc.subject.MESHAged, 80 and over-
dc.subject.MESHBlood Transfusion-
dc.subject.MESHClinical Protocols-
dc.subject.MESHFemale-
dc.subject.MESHFluid Therapy-
dc.subject.MESHHumans-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHRepublic of Korea-
dc.subject.MESHResuscitation-
dc.subject.MESHRetrospective Studies-
dc.subject.MESHSurvival Analysis-
dc.subject.MESHTrauma Centers-
dc.subject.MESHWounds and Injuries-
dc.subject.MESHYoung Adult-
dc.titleImplementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea-
dc.typeArticle-
dc.identifier.pmid29290073-
dc.contributor.affiliatedAuthor권, 준식-
dc.contributor.affiliatedAuthor조, 자윤-
dc.contributor.affiliatedAuthor허, 윤정-
dc.contributor.affiliatedAuthor이, 국종-
dc.contributor.affiliatedAuthor정, 경원-
dc.type.localJournal Papers-
dc.identifier.doi10.1007/s00268-017-4441-5-
dc.citation.titleWorld journal of surgery-
dc.citation.volume42-
dc.citation.number7-
dc.citation.date2018-
dc.citation.startPage2067-
dc.citation.endPage2075-
dc.identifier.bibliographicCitationWorld journal of surgery, 42(7). : 2067-2075, 2018-
dc.embargo.liftdate9999-12-31-
dc.embargo.terms9999-12-31-
dc.identifier.eissn1432-2323-
dc.relation.journalidJ003642313-
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Medical Humanities & Social Medicine
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