The Magic Number 63 - Redefining the Geriatric Age for Massive Transfusion in Trauma

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Geriatric Medicine

Background:

• The conventional geriatric age cutoff of 65 years may not accurately identify older adults at increased risk of mortality following massive transfusion (MT).
• There is a need to redefine the geriatric age threshold for MT to better understand its association with patient outcomes.

Purpose of the Study:

• To redefine the geriatric age threshold for massive transfusion (MT).
• To investigate the association between the redefined geriatric age and outcomes following MT.

Main Methods:

• Utilized the 2013-2018 Trauma Quality Improvement Program database for adults receiving ≥10 units of packed red blood cells (pRBCs) within 24 hours.
• Employed bootstrap analysis and logistic regression to establish transfusion futility thresholds (TTs) across various age cutoffs.
• Identified the age at which TTs for older and younger groups became statistically significant to define the new "geriatric" age for MT.

Main Results:

• The transfusion futility threshold (TT) difference became significant at a 63-year age cutoff.
• Patients aged ≥63 years (new geriatric group) had a TT of 34 units of pRBCs, compared to 40 units for those <63 years (P=0.04).
• Despite less severe injuries, the new geriatric group (n=2870) exhibited higher overall mortality (62% vs. 45%, P<0.01) and lower discharge-to-home rates (7% vs. 35%, P<0.01).

Conclusions:

• The optimal geriatric age threshold for massive transfusion (MT) is 63 years, with a transfusion futility threshold (TT) of 34 units.
• Physiologically "geriatric" patients, identified by this new threshold, experience worse outcomes after MT, including increased mortality and reduced home discharge.
• This study challenges the arbitrary 65-year cutoff and proposes a more accurate definition for identifying high-risk older adults in trauma resuscitation.