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Transfusion Futility Thresholds for Geriatric Trauma With or Without Concomitant Traumatic Brain Injury
Nikita Nunes1, Hazem Nasef, Samuel Baum
1Author Affiliations: Kiran Patel College of Osteopathic Medicine, NOVA Southeastern University, Fort Lauderdale, Florida (Mrs Nunes, Ms Amin, and Ms Patel); Kiran Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, Florida (Mr Nasef); Louisiana State University Health Sciences Center, New Orleans, Louisiana, (Mr Baum); John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii (Mr Chin); Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida (Drs Zito and Elkbuli); and Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida (Drs Zito and Elkbuli).
Background:
Geriatric trauma patients frequently require massive transfusion, yet clear guidelines on transfusion futility thresholds (TFTs) remain underdeveloped, particularly in patients with thoracoabdominal injuries and concomitant traumatic brain injury (TBI).
Objective:
To investigate TFT in geriatric trauma patients with moderate-to-severe chest and/or abdominal injuries with or without TBI.
Methods:
This retrospective cohort analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from 2017 to 2021 investigated geriatric trauma patients (age ≥65) with moderate-severe abdominal (abbreviated injury score [AIS] abdomen ≥ 2) and/or chest (AIS chest ≥ 2) injuries with or without concomitant TBI. Outcomes included mortality, transfusion threshold, ventilation-free days, complications, and intensive care unit length of stay (ICU-LOS).
Results:
There were 1,072 non-TBI and 289 TBI patients included in this analysis. The TFT was 12 units of packed red blood cells (pRBCs) among non-TBI patients and 6 units of pRBCs among TBI patients within 4 hr of arrival. Patients exceeding the TFT in both groups had significantly higher odds of 48-hr mortality (OR: 3.949, 95% CI: [2.270, 6.870], p < .001; OR: 6.426, 95% CI: [1.772, 23.311], p = .005). Non-TBI patients exceeding the TFT had higher odds of developing acute kidney injury (AKI) (OR: 2.606, 95% CI: [1.136, 5.980], p = .024), severe sepsis (OR: 6.146, 95% CI: [1.485, 25.445], p = .012), and a significantly longer ICU-LOS (B: 3.445, 95% CI: [0.903, 5.987], p = .008).
Conclusion:
Among geriatric trauma patients with abdominal and/or chest injuries with or without concomitant moderate-severe TBI, those exceeding the TFT had significantly higher odds of 48-hr mortality. Additionally, non-TBI patients exceeding the TFT had higher odds of severe sepsis and AKI. This study offers strong evidence for the establishment of massive transfusion guidelines specific to the geriatric population, particularly with or without TBI.
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