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Nationwide trends in prehospital blood product use after injury 2020-2023
Christine Carico1,2, Chandler Annesi1,2, N Clay Mann3
1Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Prehospital blood transfusions are crucial for trauma survival. Despite over 1.2 million eligible patients from 2020-2023, less than 1% received this life-saving intervention, highlighting a critical gap in care.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Prehospital blood transfusion significantly improves survival rates in trauma patients.
- Understanding demand and utilization is key to optimizing this critical intervention.
- This study focuses on adult blunt and penetrating trauma from 2020-2023.
Purpose of the Study:
- To determine the potential demand for prehospital blood products in adult trauma patients.
- To assess the current utilization of prehospital blood transfusions.
- To identify trends in demand and fulfillment over a four-year period.
Main Methods:
- Analysis of the National Emergency Medical Services Information System (NEMSIS) database (2020-2023).
- Inclusion of patients aged 16+ with blunt or penetrating injuries.
- Classification into Cohort 1 (severe hypotension/tachycardia) and Cohort 2 (high shock index) to define eligibility.
Main Results:
- Over 20.4 million trauma patients were analyzed.
- 1,227,556 patients in Cohort 2 and 262,761 in Cohort 1 were potentially eligible for transfusion.
- Demand increased significantly (p<0.001) from 2020-2023, yet less than 1% of eligible patients received transfusions, particularly in Cohort 1 (0.9%).
Conclusions:
- Approximately 1.2 million hemodynamically unstable trauma patients were eligible for prehospital transfusion between 2020-2023.
- Fewer than 1% of these patients received the intervention, indicating a substantial unmet need.
- Urgent evaluation and resolution of barriers to prehospital blood transfusion are necessary.
Introduction:
Prehospital blood transfusion improves survival after injury. Understanding potential demand for and usage of prehospital blood transfusion is important to help improve supply and utilization of this prehospital intervention. The primary objective of this study is to describe potential current demand for prehospital blood product in adults after blunt and penetrating injury from 2020 to 2023. We also estimate the extent to which this potential demand is being met.
Methods:
Patients ≥16 years with blunt/penetrating injuries included in the National Emergency Medical Services Information System (NEMSIS) from 2020 to 2023 were identified. Patients were classified into Cohort 1 (systolic blood pressure (SBP) <90 and heart rate (HR) >108 or SBP <70) and Cohort 2 (shock index ≥1), and total numbers in each cohort were reported. Additionally, the number and percentage of patients who were potentially eligible for and who received prehospital blood transfusion were calculated and trended over time.
Results:
After exclusions, 20.4 million trauma patients were included. A total of 262,761 Cohort 1 patients and 1,227,556 Cohort 2 patients were potentially eligible for transfusion. Estimated demand for blood transfusion increased from 2020 to 2023 (p < 0.001) in both cohorts. Cohort 1 had the highest estimated proportion of patients (0.9%, n = 2,289) who received transfusion, demonstrating that few potentially eligible adult trauma patients received blood product.
Conclusions:
Altogether, 1.2 million hemodynamically unstable trauma patients were potentially eligible for prehospital blood transfusion after injury during 2020-2023, yet less than 1% received this intervention. These data underscore the need to evaluate and resolve barriers to wider use of prehospital blood transfusions.
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