Dr. Jeannie Callum, director of transfusion medicine at the University of Toronto, urged transfusion specialists to speak out against the Army's "dangerous conclusion" in reviewing the service's research last April in the journal Transfusion Medicine Reviews. The Army's research, she wrote, is statistically unsound and shows "survival bias" - meaning it assumes, incorrectly, that patients who lived long enough to be treated benefited from the treatment.
U.S. Military's transfusion policy to civilian trauma patients," she wrote.
In private e-mails shared with The Sun by sources within the Army, some of the service's senior researchers and trauma experts in San Antonio applauded Callum's opposition and offered her discreet assistance in challenging the Army.
Several civilian hospitals have studied the Army's plasma ratio, with varying results. Studies in Houston and Louisiana concluded that the practice saves lives. In Denver, researchers found a higher death rate. Doctors in Alabama suggested that the ratio isn't what matters - that patients don't survive because they got more plasma, but get more plasma because they survive.
At the R Adams Cowley Shock Trauma Center in Baltimore, doctors initially endorsed the Army's transfusion practice and collected data from 806 of their patients over two years in hopes of verifying it. They concluded that the 1:1 ratio had no effect.
Dr. Thomas M. Scalea, physician in chief at Shock Trauma, presented his findings last summer at a gathering of the American Surgical Association, minutes after Holcomb presented data championing the concept. He acknowledged the military's different conclusion and said that perhaps combat injuries are too different from civilian injuries for comparison. But for whatever reason, Scalea said, in his hospital the practice didn't work.
"This was an attempt to get some traction on our own practice and to analyze what it is that we're doing - were we saving lives?" Scalea said. "Frankly, we expected the answer to be other than what we found out."
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