Analysis of Massive Transfusion Protocol Utilization in Trauma Across Sociodemographic Groups

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Critical Care

Background:

• Blood shortages pose a national crisis, necessitating judicious use of blood products during massive transfusion protocols (MTP).
• Optimizing MTP activation and resource allocation is crucial for managing trauma patients effectively.

Purpose of the Study:

• To investigate the impact of trauma characteristics, socioeconomic factors, and futility markers on MTP activation and transfusion.
• To identify key predictors influencing the likelihood of receiving MTP in trauma patients.

Main Methods:

• Retrospective analysis of 8670 trauma activations at an urban Level I trauma center (2017-2022).
• Evaluation of in-ED mortality, initial resuscitation transfusion volumes, sociodemographic data, and trauma event factors.
• Logistic regression with class balancing applied to assess MTP activation and transfusion outcomes.

Main Results:

• MTP activation and transfusion were associated with significantly higher in-ED mortality rates.
• Penetrating trauma strongly predicted MTP activation (OR 5.81) and transfusion (OR 3.63).
• Younger age, male sex, and Medicaid insurance correlated with higher MTP activation likelihood; Medicare patients were less likely.

Conclusions:

• Equitable assessment of MTP futility is essential, considering patient salvageability and low survival probability.
• Future transfusion guidelines should incorporate survival probability, age, and trauma mechanism for optimized MTP utilization.