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World Journal of Surgery
Published in: World Journal of Surgery 7/2018

01-07-2018 | Original Scientific Report

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

Authors: Kyungjin Hwang, Junsik Kwon, Jayun Cho, Yunjung Heo, John Cook-Jong Lee, Kyoungwon Jung

Published in: World Journal of Surgery | Issue 7/2018

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Abstract

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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Metadata
Title
Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea
Authors
Kyungjin Hwang
Junsik Kwon
Jayun Cho
Yunjung Heo
John Cook-Jong Lee
Kyoungwon Jung
Publication date
01-07-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 7/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4441-5

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