Predicting massive transfusion and mortality in severely injured patients presenting to the emergency of a level 1 trauma center from the Indian subcontinent

Abstract: BACKGROUND: Early management of traumatic bleeding in patients with massive hemorrhage and coagulopathy significantly reduces mortality in severely injured patients. This study aimed to identify independent predictors of massive transfusion and mortality to facilitate early risk stratification in trauma care. METHODS: We conducted a prospective observational study (August 2017–August 2018) in severely injured trauma patients of all age groups with an injury severity score (ISS) ≥16 who presented to the emergency department (ED) of a level 1 trauma center. Data on injury characteristics, clinical findings, laboratory results, and transfusion details were collected from electronic hospital and blood center records. Multivariate analysis was performed to identify predictors of massive transfusion, 24-h mortality, and inhospital mortality. RESULTS: A total of 986 severely injured patients were included in the study of whom 104 (11.8%) underwent massive transfusion. The median age of the cohort was 29 (0–92) years predominantly males (83.4%). The median ISS was 17 (16–54) and Glasgow Coma Scale 10 (3–15). Head trauma was the most common injury overall, whereas blunt abdominal trauma predominated among patients requiring massive transfusion. Multivariate analysis revealed that shock index >0.9, pulse pressure <25 mmHg, and pulse rate >120 bpm as predictors of MT. Age >56 years, activated partial thromboplastin time >37.8 s, ISS >25, mean arterial pressure < 65 mmHg, and INR >1.4 were found to increase inhospital mortality. CONCLUSION: Tachycardia, pulse pressure <25 mmHg, and shock index >0.9 were predictors of massive transfusion in ED. Patients receiving fresh frozen plasma showed survival benefits at 24 h and during the length of hospital stay. These easily obtainable variables can be used for aggressive resuscitation of severely injured trauma patients and can be included in massive transfusion protocols.