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The Effect of Socioeconomic Variables on Massive Transfusion Outcomes on Non-Trauma Patients
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A1872 - The Effect of Socioeconomic Variables on Massive Transfusion Outcomes on Non-Trauma Patients
Author Block: P. Galiatsatos1, N. Farooq2, J. Aulakh2, K. Haapanen3, M. C. Grant4, A. Martinez5; 1Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States, 2St. Agnes Hospital, Baltimore, MD, United States, 3University of California, Davis, Davis, CA, United States, 4Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, United States, 5St Agnes Hosp, Baltimore, MD, United States.
Background: Trauma patients with hemorrhagic shock requiring massive transfusion of 10 units of packed red blood cells or more in 24 hours may have improved survival if resuscitated with a prescribed massive transfusion protocol. However, massive transfusion protocol survival outcomes in non-trauma related hemorrhagic shock patients have had conflicting data. We sought to investigate if socioeconomic variables impacted the outcomes in non-trauma related hemorrhagic shock patients receiving protocolized massive transfusions. Methods: This was a retrospective observational study of all patients who received a massive transfusion protocol from 2011 to 2016 for non-traumatic non-obstetric hemorrhagic shock at an urban community hospital. We dichotomized the group into survivors versus non-survivors. We compared distribution of outcomes of interest within the two categories by Mann-Whitney U and Fisher’s exact test. Summary statistics are expressed as mean ± standard deviation Results: There were 44 patients who met criteria for and received the massive transfusion protocol. Of the 44 patients, the mean age was 64 ± 15.58 years old and 24 (54%) were female. The Charlson comorbidity index was 3.86 ± 2.10 and the sequential organ failure assessment (SOFA) score was 8.63 ± 4.67. Thirty patients (68%) had either private insurance or two or more insurances, while the remaining had Medicaid or self-pay/no insurance (32%). Eighteen (41%) of the 44 patients survived. Survivors were found to have lower SOFA scores (6.50 versus 11.50, p=0.01) and had more insurance coverage or private insurance (61% versus 42% who had no insurance/self-pay or Medicaid, p=0.002). There was no statistically significant difference between the groups in regards to age, gender, race, and Charlson comorbidity index.Conclusion: The findings suggest that non-biological factors, specifically insurance, play an important role in survival outcomes of non-trauma related hemorrhagic shock receiving massive transfusions. Further investigation is warranted to better understand how such disparities impact non-trauma hemorrhagic patients receiving protocolized massive transfusions.
Author Block: P. Galiatsatos1, N. Farooq2, J. Aulakh2, K. Haapanen3, M. C. Grant4, A. Martinez5; 1Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States, 2St. Agnes Hospital, Baltimore, MD, United States, 3University of California, Davis, Davis, CA, United States, 4Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, United States, 5St Agnes Hosp, Baltimore, MD, United States.
Background: Trauma patients with hemorrhagic shock requiring massive transfusion of 10 units of packed red blood cells or more in 24 hours may have improved survival if resuscitated with a prescribed massive transfusion protocol. However, massive transfusion protocol survival outcomes in non-trauma related hemorrhagic shock patients have had conflicting data. We sought to investigate if socioeconomic variables impacted the outcomes in non-trauma related hemorrhagic shock patients receiving protocolized massive transfusions. Methods: This was a retrospective observational study of all patients who received a massive transfusion protocol from 2011 to 2016 for non-traumatic non-obstetric hemorrhagic shock at an urban community hospital. We dichotomized the group into survivors versus non-survivors. We compared distribution of outcomes of interest within the two categories by Mann-Whitney U and Fisher’s exact test. Summary statistics are expressed as mean ± standard deviation Results: There were 44 patients who met criteria for and received the massive transfusion protocol. Of the 44 patients, the mean age was 64 ± 15.58 years old and 24 (54%) were female. The Charlson comorbidity index was 3.86 ± 2.10 and the sequential organ failure assessment (SOFA) score was 8.63 ± 4.67. Thirty patients (68%) had either private insurance or two or more insurances, while the remaining had Medicaid or self-pay/no insurance (32%). Eighteen (41%) of the 44 patients survived. Survivors were found to have lower SOFA scores (6.50 versus 11.50, p=0.01) and had more insurance coverage or private insurance (61% versus 42% who had no insurance/self-pay or Medicaid, p=0.002). There was no statistically significant difference between the groups in regards to age, gender, race, and Charlson comorbidity index.Conclusion: The findings suggest that non-biological factors, specifically insurance, play an important role in survival outcomes of non-trauma related hemorrhagic shock receiving massive transfusions. Further investigation is warranted to better understand how such disparities impact non-trauma hemorrhagic patients receiving protocolized massive transfusions.
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