Risk Factors Associated with Receiving Nonbalanced Massive Transfusion Protocol

Abstract

INTRODUCTION: Implementation of massive transfusion protocol (MTP) with balanced blood product ratios results in improved mortality rates in trauma patients. However, compliance with MTP is still not universal. Our study investigated the risk factors for receiving nonbalanced MTP (NBMTP). METHODS: We retrospectively reviewed trauma patients who received massive transfusion, defined as at least 10 units of packed red blood cells within 24 hours of admission, using the American College of Surgeons TQIP database between 2016 and 2019. Demographics, comorbidities, prehospitalization data, hospital characteristics, injury-related variables, transfusions, and clinical outcomes were abstracted. Patients who received balanced MTP (BMTP), defined as blood products transfused in a 1:1 to 1:2 ratio of fresh frozen plasma to packed red blood cells, were compared with patients who received NBMTP. Risk factors for receiving NBMTP were analyzed by Student’s t-test and chi-square test. Multivariate logistic regression was used as required. RESULTS: A total of 15,435 patients who received massive transfusions were included. Of these, 71% patients received BMTP, and 29% patients received NBMTP. Patients who received BMTP had significantly longer emergency medical services transit times to hospital (87.5 vs 99.2, p = 0.03), had a higher Injury Severity Score (32.4 vs 31.5, p = 0.001), and received more units of packed red blood cells (22.0 vs 19.6, p < 0.001). Logistic regression identified admission to Level II trauma centers (odds ratio 1.20, 95% CI 1.07 to 1.34) and lower Injury Severity Score (odds ratio 0.995, 95% CI 0.992 to 0.998) as independent risk factors for receiving NBMTP. CONCLUSION: Trauma patients at Level II trauma centers or who had lower Injury Severity Scores were less likely to receive BMTP. Clinicians should be mindful of this predisposition for decreased compliance with BMTP in these patients and institutions.