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

ABSTRACT

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 plasmapacked red blood cell (FFPpRBC) ratio cohorts (11, 12, 13, 14, 15, 16+). Our primary outcomes were 24-h and 30-day mortality. We constructed multivariable regression models with 11 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, 11 FFPpRBC ratio was independently associated with lowest 24-h mortality (12 odds ratio [OR] 1.60, 95% confidence interval [CI] 1.25-2.06, p < 0.001) and 30-day mortality (12 OR 1.44, 95% CI 1.15-1.80, p = 0.002). CONCLUSIONS: Compared to all other ratios, the 11 FFPpRBC ratio had the lowest 24-h and 30-day mortality following older adult trauma consistent with findings in the younger adult population.