M. Hamidi1, M. Zeeshan1, A. Tang1, E. Zakaria1, L. Gries1, T. O’Keeffe1, N. Kulvatunyou1, A. Jain1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA
Introduction:
Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 hours). The outcomes of patients requiring massive transfusion remains unclear. The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different trauma centers.
Methods:
We performed two years (2013-2014) retrospective analysis of the Trauma Quality Improvement program (TQIP) and included all adult trauma patients who received massive blood transfusion (MBT). We analyzed blood products given within the first 24 hours. Outcome measures were blood products received, overall mortality, mortality in the first 24 hours, complications and massive blood transfusion relationship with trauma center’s level.
Results:
A total of 416,957 patients were analyzed of which 4236 received MBT and were included in our study. Mean age was 40.6+20 years, 78.2% (n=35315) were males. Median ISS was 32 [16-40], median [IQR] GCS 8[3-15]. Mean Blood transfusion in the first 24 hours was 20+13 units, mean plasma transfusion was 13+11 units, while 4+6 units platelets and 2+6 units of cryoprecipitate were transfused in the first 24 hours. Overall mortality was 43.5%(n=1976) while 12.2%(n=556) were discharged home and 7%(n=320) were discharged to a skilled nursing facility (SNIF). Out of the 25% which died, 64% (n=1265) died on the first day, while 8.8 (n=173) died on the second day. 51.4% (n=2184) received MBT in level I while 14% (n=592) received MBT in level II trauma centers. On regression analysis after controlling for demographics and injury severity patients who were treated at Level I trauma center had lower adjusted odds of mortality (OR 0.75; 95%CI [0.3-0.8], p=0.02) compare to level II center. In addition, there was no difference in the adjusted odds of mortality based on teaching status of the hospital (p=0.61)(Community and non-teaching hospitals vs. University Hospitals).
Conclusion:
Hemorrhage continues to remain one of the most common cause of death after trauma. Almost half of the patients who receive massive transfusion died. Patients who receive massive blood transfusion in a Level I trauma centers are more likely to survive compared to level II trauma centers. Further studies are required to explore the differences in management of trauma centers to improve outcomes.