Analysis of Transfusion Volumes in the Elderly Trauma Population

Abstract

Background: Blood transfusion and old age have been independently associated with worse outcomes and higher mortality in the trauma population. Determining specific volumes and ratios of blood products for the elderly population, a special population with varied hemodynamic responses to traumatic injury, is a challenge. This study was aimed at delineating the relationship between specific transfusion volumes and mortality with an ultimate goal of finding an optimal threshold where risk outweighs benefit.

Methods: A retrospective study of data from patients aged 65 and older at a level II urban trauma center was conducted. All patients who were included in the study presented to the emergency department between January 2013 and January 2016 and received a blood product transfusion (n = 93). The primary outcome was defined as mortality 24 h after transfusion, while the secondary outcome measured was length of hospital stay. Optimal cut-off points were estimated using Youden J coefficients, and Cox proportional hazard ratio (HR) was performed to calculate mortality risk.

Results: Patients receiving less than 5 units of blood product had a shorter length of stay (5.19 days) and decreased risk of mortality (HR = 2.48, P = 0.01). Patients receiving>= 5 units of a blood product had a statistically significant increase in risk of mortality (HR = 6.207, P < 0.001) and length of hospital stay (12.47 days), regardless of injury severity score. The administration of fresh frozen plasma was also an independent predictor of mortality. Patients who received a plasma transfusion had an increased risk of mortality (HR = 3.25, P < 0.001).

Conclusion: In this study, a threshold point of greater than 5 units of blood products has been associated with increased mortality and length of hospital stay. A more restrictive transfusion strategy has potential for improved outcomes.




J Curr Surg. 2019;9(4):45-50
doi: https://doi.org/10.14740/jcs392