Inter-hospital variation in transfusion practices for severe trauma

Area of Science:

• Trauma and Emergency Medicine
• Transfusion Medicine
• Health Services Research

Background:

• Evolving transfusion practices emphasize plasma:red blood cell (RBC) ratios, with a ≥ 1:1 ratio linked to improved survival.
• Interhospital variation in plasma:RBC ratios and their impact on inpatient mortality require evaluation.

Purpose of the Study:

• To assess interhospital variability in plasma:RBC ratios among severely injured adult patients.
• To determine the association between high plasma:RBC ratios and inpatient mortality.

Main Methods:

• Analysis of 35,215 adult trauma patients from the 2020-2021 Trauma Quality Improvement Program database.
• Utilized multilevel mixed-effects models to estimate risk-adjusted plasma:RBC ratios per center, identifying High-Ratio Centers (HRC).
• Employed multivariable logistic regression to identify mortality predictors.

Main Results:

• 38.0% of patients were treated at HRCs, accounting for an estimated 17% of plasma:RBC variation.
• Care at HRCs (Adjusted Odds Ratio [AOR] 0.81) and balanced transfusions (AOR 0.92) were associated with reduced mortality.
• The benefit of HRCs persisted even in unbalanced transfusions (AOR 0.84).

Conclusions:

• Higher plasma:RBC ratios at trauma centers are associated with decreased inpatient mortality.
• This ratio serves as a valuable hospital quality metric for transfusion practices.
• Findings support the adoption of higher plasma:RBC ratios in trauma care.