Background: Hemorrhage is a common complication of trauma and requires resuscitation with blood products. We evaluated the association between red blood cell (RBC) unit transfusions with risk of all-cause mortality to hospital discharge in patients presenting to a Level 1 Trauma Center. We also assessed the effect of transfused blood units on the mortality outcomes of trauma patients of different ages.
Methods: This cross-sectional study evaluated trauma data from a Level 1 trauma center registry from January 2013 to December 2017. The main outcome measures included all-cause mortality to hospital discharge and a sub-analysis by age. Age was grouped into 16-24 (youth), 25-59 (middle age), and >=60 (older age). Data were analyzed using frequencies and means with 95%CIs.
Results: There were 11,592 patients included in the analysis, 606 (5.1%) did not survive to hospital discharge. In the youth group mortality was 109/1959 (5.6%), in middle age group 302/5969 (5.1%), and older group 195/3664 (5.3%). Overall, the mean number of units of RBC transfused was 0.3 (95%CI 0.2 -0.3) units in survivors and 4.0 units (95%CI 3.2-4.8) in non-survivors (p 0.001). In youth, survivors had 0.3 (95%CI 0.2-0.4) units and non-survivors had 5.4 (95%CI 3.1-7.6)(p 0.001). In middle age, survivors had 0.3 (95%CI 0.3-0.4) units and non-survivors had 4.6 (95%CI 3.4-5.8)(p 0.001). In the older group, survivors had 0.1 (95%CI 0.1-0.1) units and non-survivors had 2.2 (95%CI 1.1-3.2)(p 0.001). Among those that had a massive transfusion, mortality was 8.2% in youth, 8.6% in middle age, and 13% in the older age group.
Conclusion: In older patients mortality was higher in those receiving massive transfusions compared to their younger counterparts. Furthermore, older patients who did not survive received fewer units of RBC compared to young and middle age patients who appeared to survive with larger amounts of RBC unit transfusion.