Massive Transfusion in Trauma: A Retrospective analysis of MTP utilization and Futility Across Sociodemographic Groups

Author(s): Monique Arnold, Bharti Sharma, Matthew Conn, Kate Twelker, Navin D Bhatia, George Agriantonis, Sittha Cheerasarn, Jasmine Dave, Juan Mestre, Zahra Shafaee, Jennifer Whittington

Background: Blood shortages are a national crisis, creating dangerous scenarios for patients requiring massive transfusion protocol (MTP) in the trauma setting. Judicious use of blood products is critical to rescue salvageable patients while avoiding unnecessary MTP to preserve precious resources.

Methods: This retrospective study analyzed ED trauma activations from a database of an urban Level I Trauma Center were analyzed from January 1, 2017, to June 30, 2022, inclusive. In-ED mortality, RBC transfusion volumes during initial resuscitation, patient sociodemographic factors, and trauma event factors were analyzed. The primary outcomes were MTP activation and MTP transfusion. Univariable analyses and multivariable logistic regressions were conducted, applying class balancing sensitivities to the multivariable regressions to address data imbalance. Statistical significance was set at P < 0.05.

Results: Among the 8,670 trauma activations, the in-ED mortality rate was 0.3%. MTP activation and MTP transfusion were associated with higher in-ED mortality rates (3.8% and 15.4%, respectively, compared to 0.2% without MTP). Younger patients, males, and Medicaid recipients were more likely to undergo MTP activation, whereas Medicare patients were less likely. Penetrating trauma significantly increased the likelihood of both MTP activation (OR 5.81) and transfusion (OR 3.63). The logistic regression models identified penetrating trauma, lower probability of survival, and age as the most important covariates. The models demonstrated high discriminatory value (AUROC 0.876 for MTP activation, 0.935 for MTP transfusion) and precision (0.974 for activation, 0.994 for transfusion), with class balancing further enhancing model performance and precision scores.

Conclusions: These findings underscore the need for equitable assessment of MTP futility and suggest that future transfusion guidelines should consider the likelihood of patient survival, irrespective of age and trauma mechanism. Level of Evidence: Level IV, original research, case-control