Exploring Differences in Blood Product Administration by Patient Age and Injury Severity

Trauma-related hemorrhage is the leading cause of preventable death in the United States. Current resuscitation guidelines are based largely on data from younger and middle-aged adults, while influencing practice for adults of all ages. We examined age-related differences in blood product administration among individuals predicted to receive massive transfusions for the treatment of trauma-related hemorrhage.

A secondary analysis was performed using data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial, including 640 critically injured adult patients from 12 level I trauma centers across North America. We included patients aged ≥18 years, with an injury severity score of ≥9, and who had data available for packed red blood cells transfused in the first 24 hours of hospitalization. Patients were categorized based on both injury severity score (moderate, 9-15; severe, 16-24; profound, 25+) and age (young, 18-39; middle aged, 40-59; older, 60+). Descriptive statistics were used to analyze injury severity, mechanism of injury, comorbid conditions, and preinjury medication use. A negative binomial regression was used to evaluate the relationship between the quantity of packed red blood cells administered and age and injury severity categories.

Patients (N = 640) were primarily male (80.5%) and white (64.5%) who experienced either blunt (51.7%) or penetrating injuries (47%). Older adults with severe injury severity score were transfused 33% fewer units of packed red blood cells than young adults with severe injury severity score (count ratio, 0.67; 95% CI, 0.47-0.96; P = .031).

Our findings support a potential difference in the quantity of blood products administered among patients based on age. Further investigation is required to better understand age-related treatment considerations for trauma-related hemorrhage.