Outcomes After Massive Transfusion in Trauma Patients: Variability Among Trauma Centers.

Area of Science:

• Trauma Surgery
• Transfusion Medicine
• Critical Care

Background:

• Hemorrhage is a leading cause of death in trauma patients.
• Massive blood transfusion (MT), defined as ≥10 packed red blood cells (pRBCs) in 24 hours, is often required for exsanguinating trauma patients.
• Outcomes of MT vary based on trauma center level.

Purpose of the Study:

• To assess the outcomes of trauma patients receiving massive transfusion.
• To compare outcomes of MT across different trauma center levels (Level I vs. Level II).

Main Methods:

• Retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program (2013-2014).
• Included adult trauma patients who received MT.
• Outcome measures included mortality, length of stay, ICU-free and ventilator-free days, blood products transfused, and complications.

Main Results:

• Analyzed 2776 patients meeting MT criteria out of 416,957 total.
• Overall in-hospital mortality was 43.5%.
• MT at Level I trauma centers was independently associated with lower mortality (OR: 0.75 [0.46-0.96], P < 0.001).
• Higher Injury Severity Score and increased pRBC units transfused were associated with increased mortality.
• No association found between teaching status, age, gender, ED vitals, or plasma units transfused and mortality.

Conclusions:

• Hemorrhage remains a significant cause of post-trauma death.
• Nearly half of patients receiving MT did not survive.
• Patients receiving MT at Level I trauma centers demonstrated improved survival compared to those at Level II centers.