We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Mortality and Ratio of Blood Products Used in Patients With Severe Trauma

Michael T. McCurdy, MD1; Alyson Liew-Spilger, BS2; Mark Walsh, MD3
[+] Author Affiliations
1Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore
2Department of Medical Education, Memorial Hospital of South Bend, South Bend, Indiana
3Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
JAMA. 2015;313(20):2077-2078. doi:10.1001/jama.2015.4421.
Text Size: A A A
Published online


To the Editor The PROPPR trial1 confirmed the safety of a 1:1:1 ratio for units of plasma and platelets to RBCs for patients with severe trauma requiring massive transfusion compared with a 1:1:2 ratio. We have 3 questions about the study.

First, the definition of massive transfusion varies, yet the authors chose to define it as 10 U of RBCs transfused over 24 hours. Even though the 1:1:1 ratio led to early hemostasis and reduced death by exsanguination, the trial’s definition of massive transfusion may have reduced its reported efficacy.2 Lifesaving massive transfusion is often given within the first few hours of resuscitation, but many study patients received blood during the catch-up phase (hours 6 to 24). We question whether a subgroup analysis of only those who received 10 U of RBCs within the first 6 hours would reveal a shorter time to hemostasis and a greater mortality reduction from exsanguination.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




May 26, 2015
John B. Holcomb, MD; Erin E. Fox, PhD; Charles E. Wade, PhD; for the PROPPR Study Group
1Center for Translational Injury Research, University of Texas Health Science Center, Houston
JAMA. 2015;313(20):2078-2079. doi:10.1001/jama.2015.4427.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...