Prehospital transfusion: an 8-year descriptive retrospective monocenter study

Area of Science:

• Emergency Medicine
• Trauma Care
• Transfusion Medicine

Background:

• Hemorrhagic shock (HS) presents a critical prehospital challenge.
• Early identification of patients requiring massive transfusion (MT) is vital.
• Prehospital interventions with packed red blood cells (pRBCs) are increasingly considered.

Purpose of the Study:

• To compare the predictive value of Red Flag criteria versus clinical judgment (gestalt) for MT.
• To determine the proportion of prehospital interventions involving pRBCs.
• To characterize patients receiving prehospital transfusions.

Main Methods:

• Retrospective study of prehospital interventions involving RBCs (2015-2023).
• MT defined as ≥4 pRBCs or fresh frozen plasma units within 24 hours.
• Area Under the Receiver Operating Characteristic Curve (AUROC) used to compare predictive performance.

Main Results:

• Among 38,128 interventions, 105 involved pRBC transport; 11 units were discarded.
• 67% of patients received prehospital transfusion, with 57% being trauma patients.
• Gestalt (AUROC 0.81) and Red Flags (AUROC 0.80) showed similar predictive ability for MT in trauma patients (p=0.69).

Conclusions:

• Gestalt and Red Flag criteria demonstrate comparable efficacy in predicting MT.
• Gestalt's reliance on experience and lack of reproducibility highlight a need for improvement.
• Standardized decision-making tools are advocated to enhance prehospital transfusion practices.