Trends in Transfusion Strategies and Outcomes in Trauma

Temporal Trends in Transfusion Strategies and Outcomes in Trauma: A 5-Year Analysis From a Level I Trauma Center

This retrospective cohort study evaluated transfusion practices and outcomes in 137 severely injured trauma patients requiring massive transfusion at a Level I trauma center (2020-2025). This study analyzed balanced transfusion ratios, whole blood (WB) use, thromboelastography (TEG), and adjunctive hemostatic therapies to determine their impact on 30-day mortality and other clinical outcomes.

Inclusion Criteria:

Adult trauma patients (≥18 years) presenting directly to the trauma center were eligible for inclusion if they met at least one of the following criteria:

1. Injury Severity Score (ISS) ≥16, or
2. requirement for massive transfusion, defined as >10 units of packed red blood cells (PRBC) within the first 24 hours.

Exclusion Criteria:

• Death on arrival,
• Transfer from external institutions after initial resuscitation
• Incomplete transfusion or outcome data
• Significant pre-existing comorbidities (including advanced heart failure, end-stage renal disease, cirrhosis with portal hypertension, chronic oxygen dependence, or non-reversible anticoagulation therapy).
• Patients with isolated minor injuries not requiring trauma team activation were also excluded.