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Prevalence of survivor bias in observational studies on fresh frozen plasma: Erythrocyte ratios in trauma requiring massive transfusion

Ho, Anthony M.-H., Dion, Peter W., Yeung, Janice H. H., Holcomb, John B., Critchley, Lester A. H., Ng, Calvin S. H., Karmakar, Manoj K., Cheung, Chi W. and Rainer, Timothy Hudson 2012. Prevalence of survivor bias in observational studies on fresh frozen plasma: Erythrocyte ratios in trauma requiring massive transfusion. Anesthesiology 116 (3) , pp. 716-728. 10.1097/ALN.0b013e318245c47b

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Abstract

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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: Lippincott, Williams & Wilkins
ISSN: 0003-3022
Last Modified: 04 Jun 2017 09:15
URI: http://orca-mwe.cf.ac.uk/id/eprint/92684

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