Questions · Massive Transfusion and Hemorrhagic Shock
7 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
A colleague argues PROPPR proves a 1:1:1 ratio saves lives in major trauma haemorrhage. What is the precise problem with that claim, and what can you legitimately say the trial supports?
Answer: PROPPR's primary outcomes were 24-hour and 30-day all-cause mortality, and neither reached statistical significance — 12.7% versus 17.0%, and 22.4% versus 26.1%. So it did not demonstrate a mortality benefit. What it did show, in prespecified ancillary outcomes, was less death from exsanguination (9.2% vs 14.6%) and more patients achieving haemostasis (86% vs 78%), without an increase in any of 23 prespecified complications. The defensible statement is that 1:1:1 increased the proportion of patients achieving haemostasis and reduced deaths from exsanguination, at no measured safety cost.
Ancillary outcomes can be real and useful without converting a negative primary outcome into a positive trial. Say what the trial measured.
Source claim: PROPPR's primary outcomes of 24-hour and 30-day all-cause mortality showed no significant difference between 1:1:1 and 1:1:2 groups, while prespecified ancillary outcomes of exsanguination death and haemostasis favoured 1:1:1 with no difference across 23 prespecified complications.
PROPPR trial, JAMA 2015
recall · CA-2 · phrased by llm
In PROPPR, roughly how many units of plasma and platelets did the 1:1:1 group receive in the first 24 hours compared with 1:1:2, and did red cell use differ?
Answer: The 1:1:1 group received more plasma (median 7 units versus 5) and considerably more platelets (12 units versus 6), while red cell volumes were similar at about 9 units in both groups. So the ratio strategy changes what comes out of the cooler alongside the red cells, not how much red cell is given.
The intervention is plasma and platelets, delivered early. Knowing the actual unit counts makes the logistics of activating the protocol concrete.
Source claim: In PROPPR the 1:1:1 group received a median of 7 units of plasma versus 5 and 12 units of platelets versus 6, with similar amounts of red blood cells (9 units) over the first 24 hours.
PROPPR trial, JAMA 2015
recall · CA-1 · phrased by llm
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.