E. A. Alore1, C. Wilson1, M. Zielinski1 1Baylor College Of Medicine, Department Of Surgery, Houston, TX, USA
Introduction: Transfusion of whole blood ensures balanced, hemostatic resuscitation of the trauma patient. However, its widespread implementation into clinical practice has been met with logistical and financial challenges which may ultimately limit its use. We aimed to describe current practices of whole blood transfusion in trauma patients across the United Sates and define disparities in its use that may be a result of these challenges.
Methods: We reviewed the National Trauma Data Bank from 2020 of all trauma patients >18 years of age requiring blood transfusion within the first 4 hours of presentation. We further examined utilization of whole blood versus component transfusion. We performed sub analysis based on racial/ethnic minorities and insurance status. Pearson’s chi-square and multivariable logistic regression were utilized with p<0.05.
Results: Of 936,890 adult trauma patients presenting in 2020, 46,702 (5%) received a transfusion of blood products. Of those, 6,214 (13%) received whole blood, 40,645 (87%) pRBC, 24,483 (52%) plasma, and 14,365 (31%) platelets. Utilization of whole blood was more common at academic institutions (75%) versus community (20%) or non-teaching centers (5%; p<0.001) and level I trauma centers (90%) versus level II (10%) or level III institutions (0.4%; p<0.001). Patients identifying as racial/ethnic minorities made up 52% of all patients receiving whole blood despite representing only 33% of the total trauma population (Figure 1; p<0.001). Of patients receiving whole blood transfusion, 25% were on Medicaid, 25% self-pay, and 33% held private insurance (Figure 1; p<0.001). Neither racial/ethnic minorities (p=0.9) or non- or under- insured status (p=0.4) were independent predictors of whole blood transfusion on logistic regression.
Conclusion: Whole blood transfusion remains limited across the United States, representing only 13% of all blood transfusions within trauma patients. Disparities in whole blood transfusion amongst racial/ethnic minorities and those under- or non-insured were not observed.
