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Blood transfusion rates in the care of acute trauma
John J Como1, Richard P Dutton, Thomas M Scalea
1R Adams Cowley Shock Trauma Center and the Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
Insights
A small group of trauma patients consumes most red blood cell (RBC) transfusions. High-volume RBC use (over 10 units) identifies patients needing plasma and platelet transfusions for coagulopathy, with no clear futility threshold.
Area of Science:
- Trauma care
- Blood transfusion medicine
- Hemorrhage management
Background:
- Red blood cells (RBCs) are crucial in trauma care, accounting for 10-15% of all transfusions.
- Understanding RBC usage patterns is vital for resource allocation, mass casualty planning, research design, and triage optimization.
Purpose of the Study:
- To analyze red blood cell (RBC) utilization patterns in trauma patients.
- To identify characteristics and outcomes of patients receiving massive transfusions (more than 10 units of RBCs).
Main Methods:
- Linked Blood Bank and Trauma Registry records for patients admitted directly from injury scenes.
- Analyzed demographic data, Injury Severity Score (ISS), transfused products, and outcomes.
- Focused on patients receiving uncross-matched RBCs and those receiving >10 units of RBCs.
Main Results:
- 8% of trauma patients received RBCs (5219 units), with 27% mortality.
- 62% of RBCs were transfused within the first 24 hours.
- 3% of patients (147) received >10 RBC units, consuming 71% of all RBCs, with 39% mortality. These patients often received plasma (90%) and platelets (71%).
Conclusions:
- A small subset of trauma patients accounts for the majority of blood product consumption.
- Massive RBC transfusion (>10 units) identifies a high-risk group requiring concurrent plasma and platelet support for coagulopathy.
- No definitive threshold exists to declare blood product use as futile in trauma patients.
Background:
Ten to 15 percent of all RBCs are used in the care of injury. Understanding patterns of RBC use is important. Routine resource allocation, planning for mass casualty situations, designing research, and optimizing triage all can be usefully informed.
Study Design And Methods:
Blood Bank and Trauma Registry records were linked to produce a transfused blood product list for each patient directly admitted from the scene of injury to a large Level 1 trauma center in calendar year 2000. Categorical associations between demographic data, Injury Severity Score, transfused products, and outcome were sought. Special attention was paid to the groups receiving uncross-matched RBCs and more than 10 units of RBCs.
Results:
Eight percent (479/5645) of acute trauma patients received RBCs, using 5219 units and sustaining an overall mortality of 27 percent. Sixty-two percent of RBCs were given in the first 24 hours of care. Three percent of patients (147 injured) received more than 10 units and received 71 percent of all RBCs given. Mortality in this cohort was 39 percent. Ninety percent of the patients who received more than 10 units of RBCs received plasma, and 71 percent received PLTs.
Conclusions:
A small number of patients receives most of the blood products used in the treatment of injury. Transfusion of more than 10 units of RBCs identifies a subgroup where most patients received plasma and PLTs to treat actual or anticipated dilutional coagulopathy. There is no clear threshold beyond which blood use is futile.
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