Whole Blood Massive Transfusion Score is the Most Sensitive Predictor of Mortality among Patients Requiring Emergent Trauma Laparotomy and Massive Resuscitation

Abstract

Introduction: The whole blood massive transfusion score (WB MT = 3*RBC+WB) was developed to account for the use of whole blood (WB) in trauma resuscitations. A positive WB MT (WB MT ≥7) has shown to better predict mortality among patients requiring activation of massive transfusion (MTP). We sought to evaluate the ability of WB MT to predict mortality in patients with activation of MTP requiring emergent trauma laparotomy (ETL). Methods: A retrospective cohort study of all trauma patients with both ETL and activation of MTP from 11/2019-12/2021. ETL was defined as laparotomy from the trauma bay within 90 minutes of arrival. WB MT was compared with other markers of resuscitation volume [classic massive transfusion (cMT), critical administration threshold (CAT), and resuscitation intensity (RI)] on the basis of diagnostic ability to identify 24-hour and hospital mortality. Results: There were 227 patients included with 24-hour and hospital mortality rates of 18% (n = 40) and 22% (n = 51), respectively. Those with 24-hour mortality were significantly more likely to receive WB MT (100 vs 60%, p < 0.001), cMT (68 vs 13%, p < 0.001), and CAT (90 vs 42%, p < 0.001) compared with survivors. WB MT was the most sensitive predictor of 24-hour and hospital mortality compared with all other markers of massive resuscitation. Conclusion: WB MT was the most sensitive marker of mortality in patients with ETL requiring activation of MTP. Patients with 24-hour survival were significantly more likely to receive WB only MTP while those that died were significantly more likely to received mixed blood products.