Trial reportThe journal of trauma and acute care surgery2018
A comparison of resuscitation intensity and critical administration threshold in predicting early mortality among bleeding patients: A multicenter validation in 680 major transfusion patients.
Trial report in The journal of trauma and acute care surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Definitions of massive transfusion in adults with critical bleeding: a systematic review.Critical care (London, England) · 2023Pooled it
- Prognostic Accuracy of Massive Transfusion, Critical Administration Threshold, and Resuscitation Intensity in Assessing Mortality in Traumatic Patients with Severe Hemorrhage: a Meta-Analysis.Journal of Korean medical science · 2019Pooled it
- Pragmatic O-Positive Whole-blood RandoMizaTion in male trauma Patients (POWeR-MTP).European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Trial
- Prediction of massive transfusion and mortality in early trauma care: A retrospective analysis of scoring systems.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2025Article
- Prehospital transfusion: an 8-year descriptive retrospective monocenter study.BMC emergency medicine · 2025Article
- Association of Preoperative Imaging and Surgical Delay with Hemorrhagic Mortality in Abdominal Trauma: A Retrospective Multicenter Study.Journal of clinical medicine · 2025Article
- The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients.Journal of clinical medicine · 2025Review
- Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management.Journal of clinical medicine · 2025Review
- [Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services].Die Anaesthesiologie · 2024Review
- Life-threatening hemorrhage as defined by the critical administration threshold in nontraumatic critical bleeding: A descriptive observational study.Transfusion · 2024Observational
- Markers of Futile Resuscitation in Traumatic Hemorrhage: A Review of the Evidence and a Proposal for Futility Time-Outs during Massive Transfusion.Journal of clinical medicine · 2024Review
- Evaluating the Shock Index, Revised Assessment of Bleeding and Transfusion (RABT), Assessment of Blood Consumption (ABC) and novel PTTrauma score to predict critical transfusion threshold (CAT) in penetrating thoracic trauma.Scientific reports · 2024Observational
- Canadian tertiary care pediatric massive hemorrhage protocols: a survey and comprehensive national review.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome.Trauma surgery & acute care open · 2024Article
- Review
- Nonsurgical management of major hemorrhage.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Review
- Stored whole blood transfusion initiates serum amyloid A activation monitored by real-time dynamic imaging.Blood transfusion = Trasfusione del sangue · 2023Article
- Raising the bar on fibrinogen: a retrospective assessment of critical hypofibrinogenemia in severely injured trauma patients.Trauma surgery & acute care open · 2023Article
- Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data.JAMA network open · 2022Article
- Plasma, platelet and red blood cell transfusion ratios for life-threatening non-traumatic haemorrhage in medical and post-surgical patients: An observational study.Vox sanguinis · 2022Observational
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundTo address deficiencies associated with the classic definition of massive transfusion (MT), critical administration threshold (CAT) and resuscitation intensity (RI) were developed to better quantify the overall severity of illness and predict the need for transfusions and early mortality. We sought to evaluate these as more appropriate replacements for MT in defining mortality risk in patients undergoing major transfusions.
methodsPatients predicted to receive MT at 12 Level I trauma centers were randomized in the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial. MT of 10 U or greater red blood cell (RBC) in 24 hours; CAT+, 3 U or greater RBC in the first hour; and RI, total products in the first 30 minutes (1 U RBC, 1 U plasma, 1000 mL crystalloid, 500 mL colloid each valued at 1 U). Resuscitation intensity was evaluated as a continuous variable and dichotomized as RI4+, where RI is 4 U or greater. Each metric was evaluated for its ability to predict mortality at 3 hours, 6 hours, and 24 hours, and at 30 days.
resultsOf the 680 patients, 301 patients met MT definition, 521 were CAT+, and 445 were RI4+. Of those that died, 23% never reached MT threshold, but all were captured by CAT+ and RI4+. The 3-hour (9% vs. 9%), 6-hour (14% vs. 14%), 24-hour (17% vs. 18%), and 30-day mortality rates (28% vs. 29%) were similar between CAT+ and RI4+ patients. When RI was evaluated as a continuous variable, each unit increase was associated with a 20% increase in hemorrhage-related mortality (odds ratio, 1.20; 95% confidence interval, 1.15-1.29; p < 0.05).
conclusionBoth RI and CAT are valid surrogates for early mortality in patients undergoing major transfusion, capturing patients omitted by the MT definition. The CAT+ showed the best sensitivity; RI4+ demonstrated better specificity and good positive predictive values and negative predictive values. While CAT+ may be suited for patients receiving an RBC-dominant resuscitation, RI4+ is more comprehensive. RI can also be used as a continuous variable to provide quantitative as well as qualitative risk of death. LEVEL OF EVIDENCE: Prognostic, level III.
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