{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:52:24Z","timestamp":1792194744085,"version":"4.4.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"<jats:sec id=\"ab-soi220104-4\"><jats:title>Importance<\/jats:title><jats:p>Whole-blood (WB) resuscitation has gained renewed interest among civilian trauma centers. However, there remains insufficient evidence that WB as an adjunct to component therapy\u2013based massive transfusion protocol (WB-MTP) is associated with a survival advantage over MTP alone in adult civilian trauma patients presenting with severe hemorrhage.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220104-5\"><jats:title>Objective<\/jats:title><jats:p>To assess whether WB-MTP compared with MTP alone is associated with improved survival at 24 hours and 30 days among adult trauma patients presenting with severe hemorrhage.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220104-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program databank from January 1, 2017, and December 31, 2018, included adult trauma patients with a systolic blood pressure less than 90 mm Hg and a shock index greater than 1 who received at least 4 units of red blood cells within the first hour of emergency department (ED) arrival at level I and level II US and Canadian adult civilian trauma centers. Patients with burns, death within 1 hour of ED arrival, and interfacility transfers were excluded. Data were analyzed from February 2022 to September 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220104-7\"><jats:title>Exposures<\/jats:title><jats:p>Resuscitation with WB-MTP compared with MTP alone within 24 hours of ED presentation.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220104-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Primary outcomes were survival at 24 hours and 30 days. Secondary outcomes selected a priori included major complications, hospital length of stay, and intensive care unit length of stay.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220104-9\"><jats:title>Results<\/jats:title><jats:p>A total of 2785 patients met inclusion criteria: 432 (15.5%) in the WB-MTP group (335 male [78%]; median age, 38 years [IQR, 27-57 years]) and 2353 (84.5%) in the MTP-only group (1822 male [77%]; median age, 38 years [IQR, 27-56 years]). Both groups included severely injured patients (median injury severity score, 28 [IQR, 17-34]; median difference, 1.29 [95% CI, \u22120.05 to 2.64]). A survival curve demonstrated separation within 5 hours of ED presentation. WB-MTP was associated with improved survival at 24 hours, demonstrating a 37% lower risk of mortality (hazard ratio, 0.63; 95% CI, 0.41-0.96; <jats:italic>P<\/jats:italic>\u2009=\u2009.03). Similarly, the survival benefit associated with WB-MTP remained consistent at 30 days (HR, 0.53; 95% CI, 0.31-0.93; <jats:italic>P<\/jats:italic>\u2009=\u2009.02).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220104-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cohort study, receipt of WB-MTP was associated with improved survival in trauma patients presenting with severe hemorrhage, with a survival benefit found early after transfusion. The findings from this study are clinically important as this is an essential first step in prioritizing the selection of WB-MTP for trauma patients presenting with severe hemorrhage.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2022.6978","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T16:01:38Z","timestamp":1674057698000},"page":"532","source":"Crossref","is-referenced-by-count":111,"title":["Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers"],"prefix":"10.1001","volume":"158","author":[{"given":"Crisanto M.","family":"Torres","sequence":"first","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland"},{"name":"Division of Trauma and Acute Care Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair","family":"Kent","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dane","family":"Scantling","sequence":"additional","affiliation":[{"name":"Division of Trauma and Acute Care Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bellal","family":"Joseph","sequence":"additional","affiliation":[{"name":"College of Medicine, Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliott R.","family":"Haut","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland"},{"name":"Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph V.","family":"Sakran","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland"},{"name":"Johns Hopkins School of Medicine, Baltimore, Maryland"},{"name":"Johns Hopkins School of Nursing, Baltimore, Maryland"},{"name":"Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"soi220104r1","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1097\/TA.0000000000002205","article-title":"The why and how our trauma patients die: a prospective multicenter Western Trauma Association study.","volume":"86","author":"Callcut","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"issue":"6","key":"soi220104r2","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1097\/01.TA.0000069184.82147.06","article-title":"Acute traumatic coagulopathy.","volume":"54","author":"Brohi","year":"2003","journal-title":"J Trauma"},{"issue":"3","key":"soi220104r3","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1097\/TA.0000000000001333","article-title":"Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the Surgery of Trauma.","volume":"82","author":"Cannon","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"issue":"5","key":"soi220104r4","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1097\/TA.0000000000001217","article-title":"Position statement of the American College of Surgeons Committee on Trauma on the National Academies of Sciences, Engineering and Medicine Report, A National Trauma Care System: integrating military and civilian trauma systems to achieve zero preventable deaths after injury.","volume":"81","author":"Jenkins","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"soi220104r5","doi-asserted-by":"publisher","first-page":"S190","DOI":"10.1111\/trf.13491","article-title":"Whole blood for hemostatic resuscitation of major bleeding.","volume":"56","author":"Spinella","year":"2016","journal-title":"Transfusion"},{"issue":"1","key":"soi220104r6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.55460\/6WR8-NER8","article-title":"Fresh whole blood transfusion for a combat casualty in austere combat environment.","volume":"14","author":"Cordova","year":"2014","journal-title":"J Spec Oper Med"},{"issue":"6","key":"soi220104r8","doi-asserted-by":"publisher","first-page":"S445","DOI":"10.1097\/TA.0b013e3182754796","article-title":"Ten-year analysis of transfusion in Operation Iraqi Freedom and Operation Enduring Freedom: increased plasma and platelet use correlates with improved survival.","volume":"73","author":"Pidcoke","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"6","key":"soi220104r9","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1111\/tme.2016.26.issue-6","article-title":"Whole blood for the acutely haemorrhaging civilian trauma patient: a novel idea or rediscovery?","volume":"26","author":"Bahr","year":"2016","journal-title":"Transfus Med"},{"issue":"6","key":"soi220104r10","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1111\/trf.v61.6","article-title":"Survey of group A plasma and low-titer group O whole blood use in trauma resuscitation at adult civilian level 1 trauma centers in the US.","volume":"61","author":"Yazer","year":"2021","journal-title":"Transfusion"},{"issue":"S1","key":"soi220104r11","doi-asserted-by":"publisher","first-page":"S348","DOI":"10.1111\/trf.v61.S1","article-title":"Whole truths but half the blood: addressing the gap between the evidence and practice of pre-hospital and in-hospital blood product use for trauma resuscitation.","volume":"61","author":"Hashmi","year":"2021","journal-title":"Transfusion"},{"issue":"1","key":"soi220104r13","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s40560-016-0196-6","article-title":"Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview.","volume":"5","author":"Kushimoto","year":"2017","journal-title":"J Intensive Care"},{"issue":"1","key":"soi220104r14","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.injury.2017.09.015","article-title":"Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients.","volume":"49","author":"Schroll","year":"2018","journal-title":"Injury"},{"issue":"4","key":"soi220104r15","doi-asserted-by":"publisher","first-page":"R172","DOI":"10.1186\/cc12851","article-title":"The shock index revisited\u2014a fast guide to transfusion requirement? a retrospective analysis on 21,853 patients derived from the TraumaRegister DGU.","volume":"17","author":"Mutschler","year":"2013","journal-title":"Crit Care"},{"issue":"1","key":"soi220104r16","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1001\/jamasurg.2020.4350","article-title":"Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial.","volume":"156","author":"Guyette","year":"2020","journal-title":"JAMA Surg"},{"issue":"4","key":"soi220104r17","doi-asserted-by":"publisher","first-page":"e250","DOI":"10.1016\/S2352-3026(22)00040-0","article-title":"Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial.","volume":"9","author":"Crombie","year":"2022","journal-title":"Lancet Haematol"},{"issue":"2","key":"soi220104r18","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/insr.v85.2","article-title":"A tutorial on multilevel survival analysis: methods, models and applications.","volume":"85","author":"Austin","year":"2017","journal-title":"Int Stat Rev"},{"issue":"5","key":"soi220104r19","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.jamcollsurg.2011.12.013","article-title":"Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact?","volume":"214","author":"Haider","year":"2012","journal-title":"J Am Coll Surg"},{"issue":"1","key":"soi220104r20","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/j.jss.2010.09.025","article-title":"Multiple imputation in trauma disparity research.","volume":"165","author":"Oyetunji","year":"2011","journal-title":"J Surg Res"},{"issue":"4","key":"soi220104r21","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.v30.4","article-title":"Multiple imputation using chained equations: issues and guidance for practice.","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"issue":"1","key":"soi220104r22","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1093\/oxfordjournals.aje.a115101","article-title":"The impact of confounder selection criteria on effect estimation.","volume":"129","author":"Mickey","year":"1989","journal-title":"Am J Epidemiol"},{"issue":"5","key":"soi220104r23","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1111\/anae.13067","article-title":"Haemostatic profile of reconstituted blood in a proposed 1:1:1 ratio of packed red blood cells, platelet concentrate and four different plasma preparations.","volume":"70","author":"Ponschab","year":"2015","journal-title":"Anaesthesia"},{"issue":"2","key":"soi220104r24","first-page":"153","article-title":"Modelling the effects of blood component storage lesions on the quality of haemostatic resuscitation in massive transfusion for trauma.","volume":"15","author":"Mays","year":"2017","journal-title":"Blood Transfus"},{"key":"soi220104r25","doi-asserted-by":"publisher","first-page":"107S","DOI":"10.1111\/trf.2013.53.issue-s1","article-title":"Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets.","volume":"53","author":"Nessen","year":"2013","journal-title":"Transfusion"},{"issue":"4","key":"soi220104r26","doi-asserted-by":"publisher","first-page":"S69","DOI":"10.1097\/TA.0b013e31819d85fb","article-title":"Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries.","volume":"66","author":"Spinella","year":"2009","journal-title":"J Trauma"},{"issue":"3","key":"soi220104r27","doi-asserted-by":"publisher","first-page":"13","DOI":"10.55460\/DPOC-JWIY","article-title":"Fluid resuscitation for hemorrhagic shock in tactical combat casualty care: TCCC guidelines change 14-01\u20142 June 2014.","volume":"14","author":"Butler","year":"2014","journal-title":"J Spec Oper Med"},{"issue":"S3","key":"soi220104r28","doi-asserted-by":"publisher","first-page":"S180","DOI":"10.1111\/trf.v60.S3","article-title":"Improved survival in critically injured combat casualties treated with fresh whole blood by forward surgical teams in Afghanistan.","volume":"60","author":"Gurney","year":"2020","journal-title":"Transfusion"},{"issue":"S2","key":"soi220104r29","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1111\/trf.2019.59.issue-S2","article-title":"Give the trauma patient what they bleed, when and where they need it: establishing a comprehensive regional system of resuscitation based on patient need utilizing cold-stored, low-titer O+ whole blood.","volume":"59","author":"Zhu","year":"2019","journal-title":"Transfusion"},{"issue":"0 1","key":"soi220104r30","doi-asserted-by":"publisher","first-page":"137S","DOI":"10.1111\/trf.2013.53.issue-s1","article-title":"Primary hemostatic capacity of whole blood: a comprehensive analysis of pathogen reduction and refrigeration effects over time.","volume":"53","author":"Pidcoke","year":"2013","journal-title":"Transfusion"},{"issue":"4","key":"soi220104r31","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1097\/SLA.0b013e3182a4ffa0","article-title":"A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions.","volume":"258","author":"Cotton","year":"2013","journal-title":"Ann Surg"},{"issue":"2","key":"soi220104r32","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1097\/TA.0000000000002753","article-title":"Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma.","volume":"89","author":"Hanna","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"issue":"4","key":"soi220104r34","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1056\/NEJMoa1802345","article-title":"Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock.","volume":"379","author":"Sperry","year":"2018","journal-title":"N Engl J Med"},{"key":"soi220104r35","author":"Moore","year":"2018"},{"key":"soi220104r33","author":"Hazelton"},{"key":"soi220104r7","doi-asserted-by":"crossref","unstructured":"Spinella? PC, Dunne? J, Beilman? GJ, . Constant challenges and evolution of US military transfusion medicine and blood operations in combat. Transfusion. 2012;52(5):1146-1153.","DOI":"10.1111\/j.1537-2995.2012.03594.x"},{"key":"soi220104r12","unstructured":"American College of Surgeons. ACS TQIP massive transfusion in trauma guidelines. Published October 2014. Accessed December 16, 2021. https:\/\/docslib.org\/doc\/9119686\/acs-tqip-massive-transfusion-in-trauma-guidelines"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2800598\/jamasurgery_torres_2023_oi_220104_1683554116.95503.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T18:44:28Z","timestamp":1683744268000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2800598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,1]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2022.6978","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2023,5,1]]}}}