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 ORCID: https://orcid.org/0000-0003-3355-3237 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:	01 Nov 2022 10:44
URI:	https://orca.cardiff.ac.uk/id/eprint/92684

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