Examining the Utility of Point-of-Care Capillary Hemoglobin Testing and Transfusion Decisions in the Trauma Bay

BackgroundThis study evaluated a point-of-care capillary hemoglobin assay compared to physiologic indicators, such as systolic blood pressure (SBP), heart rate (HR), and Focused Assessment with Sonography in Trauma (FAST) imaging, in predicting transfusion outcomes for trauma patients.MethodsThis retrospective cohort study evaluated adult trauma patients presenting to a single Level I trauma center with an initial point-of-care capillary hemoglobin (POC-Hb; HemoCue®) obtained in the trauma bay. Patients were stratified by receipt of blood transfusion within 24 hours of arrival. Prehospital and emergency department vital signs, FAST results, transfusion timing, and volume were analyzed. Multivariable logistic regression identified variables independently associated with transfusion. Nonparametric tests (Mann-Whitney U, Kruskal-Wallis with post-hoc testing) and Spearman's rank correlation assessed associations between POC-Hb values and transfusion timing and volume.ResultsOf 1552 included patients, 552 received blood transfusions and had significantly lower POC-Hb values compared to non-transfused patients (11.5 vs 13.5 g/dL; P < 0.001). POC-Hb was not associated with transfusion on multivariable analysis, and showed no correlation with time to transfusion. Positive FAST results (OR 19.4, 95% CI 8.1-46.2, P < 0.001) and SBP on arrival (OR 48.5, 95% CI 15.0-156.7, P < 0.001) were associated with transfusion.ConclusionLower initial POC-Hb was associated with transfusion and weakly correlated with blood product volume on unadjusted analyses, but was not independently associated with transfusion or with time to transfusion after adjustment. SBP and FAST demonstrated stronger associations with transfusion outcomes and intensity. These findings support prioritizing physiologic indicators and FAST results over point-of-care hemoglobin when assessing transfusion need in trauma patients.