Platelet Transfusion and Outcomes After Massive Transfusion Protocol Activation for Major Trauma: A Retrospective...

Area of Science:

• Trauma care
• Hematology
• Critical care medicine

Background:

• Massive transfusion protocols (MTPs) reduce hemorrhagic deaths in trauma.
• Platelet transfusion timing and thresholds in MTPs remain debated.
• Rapid platelet count availability is crucial for timely transfusion decisions.

Purpose of the Study:

• To evaluate early (first 4 hours) platelet transfusion practices in trauma patients.
• To determine the effect of early platelet transfusion on in-hospital mortality.
• To test the hypothesis that platelet transfusion guided by rapid counts does not increase mortality.

Main Methods:

• Analysis of MTP activations at a Level 1 trauma center (October 2016-September 2018).
• Characterization of platelet transfusion practices based on patient demographics, injury severity, and vital signs.
• Multivariable modeling to assess the association between early platelet transfusion and mortality outcomes.

Main Results:

• Of 469 massively transfused patients, 53% received early platelets, often within the first hour.
• Platelet recipients had higher injury severity and shock index, and received more red blood cells.
• No significant difference in 4-hour, 24-hour, or in-hospital mortality was observed between platelet recipients and nonrecipients.

Conclusions:

• Early platelet transfusion in trauma is feasible with rapid platelet count availability.
• Protocol-guided early platelet transfusion did not increase mortality in this cohort.
• This practice supports evidence-based transfusion strategies in acute trauma resuscitation.