摘要: The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study: Comparative Effectiveness of a Time-Varying Treatment With Competing RisksJohn B. Holcomb, MD; Deborah J. del Junco, PhD; Erin E. Fox, Charles Wade, Mitchell Cohen, Martin A. Schreiber, Louis H. Alarcon, Yu Bai, MD, Karen Brasel, MPH; Eileen M. Bulger, Bryan Cotton, Nena Matijevic, Peter Muskat, John G. Myers, Herb Phelan, MSCS; Christopher White, Jiajie Zhang, Mohammad Rahbar, for the PROMMTT Study GroupObjective: To relate in-hospital mortality to early transfusion plasma and/or platelets and time-varying plasma:red blood cell (RBC) platelet:RBC ratios.Design: Prospective cohort study documenting timing transfusions during active resuscitation patient outcomes. Data were analyzed using time-dependent proportional hazards models.Setting: Ten US level I trauma centers.Patients: Adult patients surviving 30 minutes after admission who received at least 1 unit RBCs within 6 hours (n = 1245, original group) 3 total units (of RBCs, plasma, or platelets) 24 (n = 905, analysis group).Main Outcome Measure: In-hospital mortality.Results: Plasma:RBC ratios not constant first (P < .001 both). In multivariable Cox model, increased plasma:RBCs (adjusted hazard ratio = 0.31; 95% CI, 0.16-0.58) platelets:RBCs ratio = 0.55; 0.31-0.98) independently associated with decreased 6-hour mortality, when hemorrhagic death predominated. hours, less than 1:2 4 times more likely die 1:1 higher. After platelet unassociated competing risks from nonhemorrhagic causes prevailed.Conclusions: Higher in products admission. Among survivors subsequent risk by day was ratios.JAMA Surg. 2013; 148(2):127-136.doi:10.1001/2013.jamasurg.387
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