Blood Utilization and Thresholds for Mortality Following Major Trauma

Abstract

IntroductionBlood loss is a hallmark of traumatic injury. Massive transfusion, historically defined as the replacement by transfusion of 10 units of packed red blood cells (PRBCs) in 4 h, is a response to uncontrolled hemorrhage. We sought to identify blood transfusion thresholds in which predicted mortality exceeds 50%. MethodsWe analyzed the 2017-2019 National Trauma Database. Inclusion criteria included patients ≥18 y who received ≥1 unit of PRBCs. Statistical analysis included bivariate analysis, logistic regression for mortality, and adjusted predicted probability modeling was utilized. ResultsWe identified 61,676 patients for analysis. The 50% predicted mortality for all patients was 31 PRBC units. The 50% predicted mortality was 6 units of PRBCs for elderly trauma patients 80 y and older. ConclusionsBlood remains as scarce resource in hospitals especially with trauma. Patients receiving a massive transfusion over a short period of time may exhaust blood bank supply with diminishing survival benefit. Surgeons should be judicious regarding continued blood usage once the 50% predicted mortality threshold is reached.