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Updated: Aug 12, 2025
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Establishing a core outcomes set for massive transfusion: An Eastern Association for the Surgery of Trauma modified
Rondi B Gelbard1, Jeffry Nahmias, Saskya Byerly
1From the Division of Trauma and Acute Care Surgery, Department of Surgery (R.B.G., J.B.H., J.K.), University of Alabama at Birmingham, Birmingham, Alabama; Division of Trauma, Burns and Surgical Critical Care (J.N.), University of California, Irvine, Orange, California; Department of Surgery (S.B.), University of Tennessee Health Science Campus, Memphis, Tennessee; Department of Surgery (M.Z.), University of Manitoba, Winnipeg, Manitoba, Canada; Department of Surgery (D.S.), R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery (J.W.S.), University of Louisville School of Medicine, Louisville, Kentucky; Division of Trauma, Acute Care and Critical Care Surgery, Department of Surgery (M.B.), Penn State Hershey Medical Center, Hershey, Pennsylvania; Department of Surgery (B.Z.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Pathology and Molecular Medicine (J.C.), School of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Surgery (B.A.C.), University of Texas Health McGovern Medical School, Houston, Texas; Department of Surgery (M.C.), University of Colorado Hospital, Aurora, Colorado; Department of Surgery (O.L.G.), Division of Acute Care Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (L.Z.K.), Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M., D.D.Y.), University of Colorado Denver, Denver, Colorado; Department of Surgery (C.M.R.), Brooke Army Medical Center, San Antonio, Texas; Department of Surgery (M.S.), Oregon Health and Science University, Portland, Oregon; and Department of Surgery (J.L.S.), UPMC Presbyterian, Pittsburgh, Pennsylvania.
Background:
The management of severe hemorrhage has changed significantly over recent decades, resulting in a heterogeneous description of diagnosis, treatment, and outcomes in the literature, which is not suitable for data pooling. Therefore, we sought to develop a core outcome set (COS) to help guide future massive transfusion (MT) research and overcome the challenge of heterogeneous outcomes reporting.
Methods:
Massive transfusion content experts were invited to participate in a modified Delphi study. For Round 1, participants submitted a list of proposed core outcomes. In subsequent rounds, panelists used a 9-point Likert scale to score proposed outcomes for importance. Core outcomes consensus was defined as >85% of scores receiving 7 to 9 and <15% of scores receiving 1 to 3. Feedback and aggregate data were shared between rounds.
Results:
From an initial panel of 16 experts, 12 (75%) completed three rounds of deliberation to reevaluate variables not achieving predefined consensus criteria. A total of 64 items were considered, with 4 items achieving consensus for inclusion as core outcomes: blood products received in the first 6 hours, 6-hour mortality, time to mortality, and 24-hour mortality.
Conclusion:
Through an iterative survey consensus process, content experts have defined a COS to guide future MT research. This COS will be a valuable tool for researchers seeking to perform new MT research and will allow future trials to generate data that can be used in pooled analyses with enhanced statistical power.
Level Of Evidence:
Diagnostic Test or Criteria; Level V.
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