Need for Blood Transfusion Volume Is Associated With Increased Mortality in Severe Traumatic Brain Injury

Area of Science:

• Trauma Surgery
• Neurocritical Care
• Emergency Medicine

Background:

• Patients with isolated severe traumatic brain injury (sTBI) often receive blood transfusions upon arrival due to hypotension.
• The impact of blood transfusion volume on mortality in these patients requires further investigation.

Purpose of the Study:

• To investigate the association between the volume of blood products transfused and in-hospital mortality in patients with isolated sTBI.
• To determine if increasing packed red blood cells (pRBC) or fresh frozen plasma (FFP) transfusions within the first 4 hours impacts mortality.

Main Methods:

• A review of trauma quality improvement program (TQIP) and single-center databases (2017-2019 and 2013-2021, respectively) was conducted.
• Patients with isolated sTBI (Abbreviated Injury Scale head ≥3, others ≤2) were identified.
• Data collected included demographics, injury severity, initial vitals, transfusion volumes (pRBC, FFP), FFP/pRBC ratio, and in-hospital mortality.

Main Results:

• In the TQIP database (9257 patients), mortality was 47.3%. Each additional unit of pRBC transfused increased mortality by approximately 4%, reaching 74% with 11+ units.
• Adjusted analysis in TQIP showed pRBC volume, FFP volume, and FFP/pRBC ratio were associated with mortality.
• In the single-center study (138 patients), logistic regression found no significant association between transfusion volumes/ratios and mortality, though the mortality rate was high (60.1%).

Conclusions:

• Increasing volumes of pRBC and FFP transfusions within the first 4 hours of arrival are associated with higher mortality rates in patients with isolated sTBI.
• Findings suggest a potential need to re-evaluate transfusion protocols in this patient population.