Blood Transfusion Factors that affect the Outcomes of Patients who Experienced Trauma-related Hemorrhage

Authors

• Justin Lee Miller, University of Alabama at Birmingham

Advisor(s)

Patricia Patrician
Allison Jones

Committee Member(s)

Elizabeth Mann-Salinas
John Holcomb
Michelle Brown
Peng Li

School

School of Nursing

Document Type

Dissertation

Department (new version)

Nursing

Date of Award

9-9-2024

Abstract

Trauma is a leading cause of death in the United States and in the world. It is the leading cause of death of Americans between the ages of one to 45 years old and is expected to increase due to increase over the next ten years. Most trauma deaths are attributed to hemorrhage and are considered preventable. The current standard of care for trauma-related hemorrhage (TRH) is damage control resuscitation using either whole blood (WB) or blood components (BC) in a ratio of 1 unit of red blood cells to 1 unit of plasma to 1 unit of platelets. The purpose of this dissertation was threefold. First, a systematic review of the outcomes of patients who received blood transfusions to treat TRH was presented. Next, the finding of a randomized, crossover trial using in situ simulation focused on an adult patient experiencing TRH to assess nursing workload and time to transfusion completion using WB and BC scenarios was reported. Finally, the results of a survival analysis using a Kaplan-Meier approach and Cox Regression modeling of a secondary data analysis of the intermediate- and long-term outcomes of patients who receive WB or BC transfusions for the treatment of TRH was described. The resulting work identified gaps in the intermediate- and long-term outcomes of patients who receive WB or BC following a TRH. It identified that the transfusion of WB to a simulated trauma patient was quicker and required less overall workload, less mental demand, and less effort, and participants rated their performance higher when transfusing WB compared to BC. Additionally, the transfusion of WB was nearly ten minutes faster than the transfusion of BC. Finally, there were differences in the hospital length of stay during the intermediate- and long-term timeframes. Univariate time-to-event analysis demonstrated a lower risk of mortality, sepsis, deep vein thrombosis, pulmonary embolism, acute kidney injury, and acute lung injury for patients who received WB compared to BC during the intermediate- and long-term timeframes. After the Cox Regression was adjusted, only the decreased risk of developing sepsis in the WB group when compared to the BC group, remained.

ProQuest ID

https://proquest.com/docview/3101955938