Massive blood transfusion following older adult trauma: The effect of blood ratios on mortality

• Published in: Academic emergency medicine Vol. 29; no. 12; pp. 1422 - 1430
• Main Authors: Hohle, Rae D., Wothe, Jillian K., Hillmann, Benjamin M., Tignanelli, Christopher J., Harmon, James V., Vakayil, Victor R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-12-2022; John Wiley and Sons Inc
• Subjects: Aged; Aged, 80 and over; Blood; Blood Component Transfusion; blood ratio; Blood Transfusion; Blood transfusions; Emergency medical care; Erythrocyte Transfusion; Female; Humans; Male; massive blood transfusion; Mortality; older adult; Older people; Original Contribution; Original Contributions; Plasma; Retrospective Studies; TQIP; trauma; Wounds and Injuries - therapy; blood ratio; older adult; trauma; TQIP; massive blood transfusion
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.14580

Background
Massive blood transfusion (MBT) following older adult trauma poses unique challenges. Despite extensive evidence on optimal resuscitative strategies in the younger adult patients, there is limited research in the older adult population.
Methods
We used the Trauma Quality Improvement Program (TQIP) database from 2013 to 2017 to identify all patients over 65 years old who received a MBT. We stratified our population into six fresh‐frozen plasma:packed red blood cell (FFP:pRBC) ratio cohorts (1:1, 1:2, 1:3, 1:4, 1:5, 1:6+). Our primary outcomes were 24‐h and 30‐day mortality. We constructed multivariable regression models with 1:1 group as the baseline and adjusted for confounders to estimate the independent effect of blood ratios on mortality.
Results
A total of 3134 patients met our inclusion criteria (median age 73 ± 7.6 years, 65% male). On risk‐adjusted multivariable analysis, 1:1 FFP:pRBC ratio was independently associated with lowest 24‐h mortality (1:2 odds ratio [OR] 1.60, 95% confidence interval [CI] 1.25–2.06, p < 0.001) and 30‐day mortality (1:2 OR 1.44, 95% CI 1.15–1.80, p = 0.002).
Conclusions
Compared to all other ratios, the 1:1 FFP:pRBC ratio had the lowest 24‐h and 30‐day mortality following older adult trauma consistent with findings in the younger adult population.