B. J. Hazen2, J. Nguyen3,4, R. B. Gelbard2,4, C. J. Dente2,4, B. M. Tracy1 1Ohio State University,Trauma, Critical Care, Burn,Columbus, OH, USA 2Emory University School Of Medicine,Surgery,Atlanta, GA, USA 3Morehouse School of Medicine,Surgery,Atlanta, GA, USA 4Grady Memorial Hospital,Acute Care Surgery,Atlanta, GA, USA
Introduction: Cold-stored, group O+ whole blood (WB) may provide a survival benefit compared to component therapy (CT) alone. Using data immediately available during trauma resuscitations, we sought to determine which patients have the greatest survival benefit from WB.
Methods: We retrospectively reviewed patients from 2018-2019 who received emergency release blood products during their resuscitation. We excluded patients < 16 years, women, and patients who died in the trauma bay. Propensity score matching was performed (1 WB: 2 CT) using age, mechanism (blunt/penetrating), and revised trauma score (RTS). RTS combines respiratory rate, GCS, and systolic blood pressure. Median time until death for all expired patients was determined; any patient who expired by the corresponding upper interquartile range time was classified as a mortality for analysis. Recursive partitioning (classification tree analysis) was then used to split patients into groups with significantly different mortality rates based on the predictor variables of RTS and WB vs CT.
Results: 141 patients comprised the matched cohort; 47 WB and 94 CT. Median age was 33 (IQR 25-49) years, mean RTS 5.8 (1.9), and 58.9% had penetrating injury. There was no difference in ISS between groups (26 vs 26.5, p = 0.71). 38 patients expired with a median time until death of 1 (IQR 1-5) days; 81.6% (31/38) died within 5 days of admission. Using 5-day mortality rates, recursive partitioning first split the cohort at an RTS of 4.3, then split the RTS < 4.3 group at transfusion type. Mortality was significantly lower for patients who received WB compared to CT alone (25% vs 60%, p = 0.04).
Conclusion: Patients with lower RTS who received WB had a significantly lower 5-day mortality rate. The RTS may be a useful tool to determine who benefits most from WB transfusion during civilian trauma resuscitations.
