Blood Utilization and Thresholds for Mortality Following Major Trauma

Area of Science:

• Trauma surgery
• Hemorrhage management
• Blood transfusion medicine

Background:

• Massive transfusion, defined as 10 units of packed red blood cells (PRBCs) in 4 hours, is a critical response to uncontrolled hemorrhage in trauma.
• Blood is a scarce resource, and massive transfusions can deplete hospital supplies with diminishing survival benefits.

Purpose of the Study:

• To identify critical blood transfusion thresholds associated with a predicted mortality exceeding 50% in trauma patients.
• To inform clinical decision-making regarding the judicious use of blood products during massive transfusion events.

Main Methods:

• Analysis of the 2017-2019 National Trauma Database, including 61,676 patients who received at least one unit of PRBCs.
• Utilized bivariate analysis, logistic regression for mortality prediction, and adjusted predicted probability modeling.

Main Results:

• The overall threshold for 50% predicted mortality was 31 units of PRBCs.
• Elderly trauma patients (≥80 years) reached a 50% predicted mortality threshold at 6 units of PRBCs.

Conclusions:

• Surgeons should exercise caution with continued blood administration once the 50% predicted mortality threshold is approached.
• Optimizing blood product utilization is crucial, especially in resource-limited settings and for vulnerable patient populations like the elderly.