A normal platelet count may not be enough: The impact of admission platelet count on mortality and transfusion in severely injured trauma patients

Lisa M Brown, Mariah S. Call, M. Margaret Knudson, Mitchell J. Cohen, Trauma Outcomes Group The Trauma Outcomes Group

Research output: Contribution to journalArticle

68 Citations (Scopus)

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 × 10/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 × 10/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 × 10/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.

Original languageEnglish (US)
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number2 SUPPL. 3
DOIs
StatePublished - Aug 2011

Fingerprint

Platelet Count
Mortality
Wounds and Injuries
Confidence Intervals
Erythrocytes
Erythrocyte Transfusion
Platelet Transfusion
Hemostasis
Reference Values
Cohort Studies
Blood Platelets
Retrospective Studies

Keywords

  • Massive transfusion
  • Mortality
  • Platelet count

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A normal platelet count may not be enough : The impact of admission platelet count on mortality and transfusion in severely injured trauma patients. / Brown, Lisa M; Call, Mariah S.; Margaret Knudson, M.; Cohen, Mitchell J.; The Trauma Outcomes Group, Trauma Outcomes Group.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 2 SUPPL. 3, 08.2011.

Research output: Contribution to journalArticle

Brown, Lisa M ; Call, Mariah S. ; Margaret Knudson, M. ; Cohen, Mitchell J. ; The Trauma Outcomes Group, Trauma Outcomes Group. / A normal platelet count may not be enough : The impact of admission platelet count on mortality and transfusion in severely injured trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. 2 SUPPL. 3.
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T2 - The impact of admission platelet count on mortality and transfusion in severely injured trauma patients

AU - Brown, Lisa M

AU - Call, Mariah S.

AU - Margaret Knudson, M.

AU - Cohen, Mitchell J.

AU - The Trauma Outcomes Group, Trauma Outcomes Group

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N2 - 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 × 10/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 × 10/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 × 10/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.

AB - 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 × 10/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 × 10/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 × 10/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.

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KW - Mortality

KW - Platelet count

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