Utilizing Group-based Trajectory Modeling to Understand Patterns of XXXX and Resuscitation.

@entity1 @entity1913 @entity130 @entity548
OBJECTIVE: The purpose of this study was to describe variations in blood-based resuscitation in an injured cohort. We hypothesize that distinct transfusion trajectories are present. BACKGROUND: Retrospective studies of @entity548 utilize the concept of massive transfusion, where a set volume of blood is required. Patterns of @entity548 vary and massive transfusion does little to describe these differences. METHODS: @entity1 were prospectively included from June 2012 to 2013. Time of transfusion for each packed red blood cell (PRBC) transfused was recorded, in minutes, for all @entity1 . Additional measures included @entity130 data, admission laboratory values, and vital signs and outcomes including mortality, tempo of transfusion, and operative requirements. Group-based trajectory modeling was utilized to describe transfusion trajectories throughout the cohort. RESULTS: Three hundred sixteen @entity1 met the inclusion criteria. Among them, 72% were @entity1 and median age was 35 years (interquartile range [IQR] 24-50), median injury severity score was 13 (IQR 9-22), median 24-hour transfusion volume was 4 units of PRBCs (IQR 2-8), and mortality was 14%. Six transfusion trajectories were identified. Among the @entity1 , 35% received negligible transfusions (group 1). Groups 2 and 3 received greater than 15 units PRBCs-the former as early resuscitation, whereas the latter intermittently throughout the day. Groups 4 and 5 had similar small resuscitations with distinct demographic differences. Group 6 suffered @entity1913 and required rapid resuscitation. CONCLUSIONS: Traditional definitions of massive transfusion are broad and imprecise. In cohorts of severely injured @entity1 , there are distinct, identifiable transfusion trajectories. Identification of subgroups is important in understanding clinical course and to anticipate resuscitative and therapeutic needs.
