A Normal Platelet Count May Not Be Enough: The Impact of Admission Platelet Count on Mortality and Transfusion in Severely Injured Trauma Patients
- 1 August 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Trauma-Injury Infection and Critical Care
- Vol. 71 (2), S337-S342
- https://doi.org/10.1097/ta.0b013e318227f67c
Abstract
Background: Platelets play a central role in hemostasis after trauma. However, the platelet count of most trauma patients does not fall below the normal range (100–450 × 109/L), and as a result, admission platelet count has not been adequately investigated as a predictor of outcome. The purpose of this study was to examine the relationship between admission platelet count and outcomes after trauma. Methods: A retrospective cohort study of 389 massively transfused trauma patients. Regression methods and the Kruskal-Wallis test were used to test the association between admission platelet count and 24-hour mortality and units of packed red blood cells (PRBCs) transfused. Results: For every 50 × 109/L increase in admission platelet count, the odds of death decreased 17% at 6 hours (p = 0.03; 95% confidence interval [CI], 0.70–0.99) and 14% at 24 hours (p = 0.02; 95% CI, 0.75–0.98). The probability of death at 24 hours decreased with increasing platelet count. For every 50 × 109/L increase in platelet count, patients received 0.7 fewer units of blood within the first 6 hours (p = 0.01; 95% CI, −1.3 to −0.14) and one less unit of blood within the first 24 hours (p = 0.002; 95% CI, -1.6 to -0.36). The mean number of units of PRBCs transfused within the first 6 hours and 24 hours decreased with increasing platelet count. Conclusions: Admission platelet count was inversely correlated with 24-hour mortality and transfusion of PRBCs. A normal platelet count may be insufficient after severe trauma, and as a result, these patients may benefit from a lower platelet transfusion threshold. Future studies of platelet number and function after injury are needed.Keywords
This publication has 26 references indexed in Scilit:
- Prehospital Hypotension in Blunt Trauma: Identifying the “Crump Factor”Journal Of Trauma-Injury Infection and Critical Care, 2011
- Association of Shock, Coagulopathy, and Initial Vital Signs With Massive Transfusion in Combat CasualtiesJournal Of Trauma-Injury Infection and Critical Care, 2010
- Resuscitation and transfusion principles for traumatic hemorrhagic shockBlood Reviews, 2009
- Coagulopathy in trauma patients: importance of thrombocyte function?Current Opinion In Anesthesiology, 2009
- Increased Plasma and Platelet to Red Blood Cell Ratios Improves Outcome in 466 Massively Transfused Civilian Trauma PatientsAnnals of Surgery, 2008
- Increased Mortality Associated With the Early Coagulopathy of Trauma in Combat CasualtiesJournal Of Trauma-Injury Infection and Critical Care, 2008
- Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT StudyJournal of Neurotrauma, 2007
- Blood transfusion rates in the care of acute traumaTransfusion, 2004
- Quantitative Measurement of Thromboelastography as a Function of Platelet CountAnesthesia & Analgesia, 1999
- Quantitative Measurement of Thromboelastography as a Function of Platelet CountAnesthesia & Analgesia, 1999