Prevalence of Survivor Bias in Observational Studies on Fresh Frozen Plasma:Erythrocyte Ratios in Trauma Requiring Massive Transfusion

被引:102
作者
Ho, Anthony M. -H. [1 ]
Dion, Peter W. [1 ]
Yeung, Janice H. H. [1 ]
Holcomb, John B. [1 ]
Critchley, Lester A. H. [1 ]
Ng, Calvin S. H. [1 ]
Karmakar, Manoj K. [1 ]
Cheung, Chi W. [1 ]
Rainer, Timothy H. [1 ]
机构
[1] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Shatin, Hong Kong, Peoples R China
关键词
RED-BLOOD-CELLS; DAMAGE CONTROL RESUSCITATION; PLASMA TRANSFUSION; EXSANGUINATION PROTOCOL; IMPROVES SURVIVAL; BLEEDING PATIENTS; AGGRESSIVE USE; PRODUCT RATIO; MAJOR TRAUMA; MORTALITY;
D O I
10.1097/ALN.0b013e318245c47b
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Observational studies on transfusion in trauma comparing high versus low plasma: erythrocyte ratio were prone to survivor bias because plasma administration typically started later than erythrocytes. Therefore, early deaths were categorized in the low plasma: erythrocyte group, whereas early survivors had a higher chance of receiving a higher ratio. When early deaths were excluded, however, a bias against higher ratio can be created. Survivor bias could be reduced by performing before-and-after studies or treating the plasma: erythrocyte ratio as a time-dependent covariate. We reviewed 26 studies on blood ratios in trauma. Fifteen of the studies were survivor bias-unlikely or biased against higher ratio; among them, 10 showed an association between higher ratio and improved survival, and five did not. Eleven studies that were judged survivor bias-prone favoring higher ratio suggested that a higher ratio was superior. Without randomized controlled trials controlling for survivor bias, the current available evidence supporting higher plasma: erythrocyte resuscitation is inconclusive.
引用
收藏
页码:716 / 728
页数:13
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