G.S. Mohamed1,2, V.S. Panossian1, I.C. Nzenwa1, V.P. Van Zon1, S.E. Manyitabot1,3, G.C. Velmahos1,4, H.M. Kaafarani1,4, C.N. Paranjape1,4, J.O. Hwabejire1,4 1Massachusetts General Hospital, Division Of Trauma, Emergency Surgery & Surgical Critical Care, Boston, MA, USA 2Brown University, Providence, RI, USA 3Medical College Of Wisconsin, Milwaukee, WI, USA 4Harvard School Of Medicine, Brookline, MA, USA
Introduction: Disparities in healthcare access and outcomes across racial and ethnic groups are well-documented, yet the potential inequities in blood product administration during acute trauma care, particularly for gunshot wound (GSW) patients, remain underexplored. This study seeks to fill this gap by examining racial differences in the administration of blood products to GSW patients.
Methods: Data from the 2017-2018 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database was retrospectively analyzed. The study included GSW patients aged 18 years and older who presented with an emergency department systolic blood pressure (ED SBP) of less than 90 mmHg. Patients with bleeding disorders or those on anticoagulants were excluded. Propensity score matching was employed to compare the administration of blood products between Black and White patients, matching individuals based on factors such as injury severity score, ED Glasgow Coma Scale, body mass index, and injury location. The primary outcomes assessed were whether blood was administered, the occurrence of massive blood transfusions (>10 pRBC units within 4 and 24 hours), and the total blood volume administered within these timeframes. Secondary outcomes included morbidity, hospital length of stay, and composite complications.
Results: A total of 6,521 patients met the inclusion criteria, with a mean age of 35 years; 43.3% were White, and 56.7% were Black. Overall, 46.1% of patients received blood, and 12.0% underwent massive transfusions. Among the 1,448 matched patients, Black patients were significantly less likely to receive a massive transfusion than White patients (15.1% vs. 20.3%, p=0.009) and received lower total volumes of blood within both 4 and 24 hours. However, there was no significant difference in the likelihood of receiving any blood transfusion (56.5% vs. 61.2%, p= 0.078).
Conclusion: This study reveals significant racial disparities in the administration of blood products for GSW patients, with Black patients receiving less intensive transfusion treatment compared to White patients, despite similar rates of receiving any blood transfusion. These findings point to potential biases or inequities in trauma care that merit further investigation. Addressing these disparities is crucial for standardizing transfusion practices and ensuring equitable treatment for all patients, regardless of race.