The association of blood component use ratios with the survival of massively transfused trauma patients with and without severe brain injury

J Trauma. 2011 Aug;71(2 Suppl 3):S343-52. doi: 10.1097/TA.0b013e318227ef2d.


Background: The effect of blood component ratios on the survival of patients with traumatic brain injury (TBI) has not been studied.

Methods: A database of patients transfused in the first 24 hours after admission for injury from 22 Level I trauma centers over an 18-month period was queried to find patients who (1) met different definitions of massive transfusion (5 units red blood cell [RBC] in 6 hours vs. 10 units RBC in 24 hours), (2) received high or low ratios of platelets or plasma to RBC units (<1:2 vs. ≥ 1:2), and (3) had severe TBI (head abbreviated injury score ≥ 3) (TBI+).

Results: Of 2,312 total patients, 850 patients were transfused with ≥ 5 RBC units in 6 hours and 807 could be classified into TBI+ (n = 281) or TBI- (n = 526). Six hundred forty-three patients were transfused with ≥ 10 RBC units in 24 hours with 622 classified into TBI+ (n = 220) and TBI- (n = 402). For both high-risk populations, a high ratio of platelets:RBCs (not plasma) was independently associated with improved 30-day survival for patients with TBI+ and a high ratio of plasma:RBCs (not platelets) was independently associated with improved 30-day survival in TBI- patients.

Conclusions: High platelet ratio was associated with improved survival in TBI+ patients while a high plasma ratio was associated with improved survival in TBI- patients. Prospective studies of blood product ratios should include TBI in the analysis for determination of optimal use of ratios on outcome in injured patients.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Blood Component Transfusion*
  • Brain Injuries / blood
  • Brain Injuries / mortality*
  • Brain Injuries / therapy*
  • Erythrocyte Count
  • Female
  • Humans
  • Male
  • Middle Aged
  • Platelet Count
  • Retrospective Studies
  • Survival Rate
  • Trauma Centers
  • Treatment Outcome
  • Young Adult