Age-Related Mortality in Trauma Patients Requiring Massive Transfusion

Background Massive transfusion (MT) protocols improve survival in trauma patients. Elderly trauma patients requiring MT represent a high-risk population, yet outcome data remain limited. Understanding age-related differences is critical to guide resuscitation and resource allocation. Objective To characterize the association between MT and mortality in elderly vs younger trauma patients. Participants Trauma patients at a Level I trauma center (1/2013-09/2024) who required MT (≥10 units of whole blood (WB) and/or packed red blood cells (pRBC) within 24 h) were included. Patients ≥65 (elderly) were compared to <65 (non-elderly). The primary outcome was 30-day mortality. Secondary outcomes included ICU and hospital length of stay (LOS), and ventilator days. Results Of 368 patients meeting inclusion criteria, 30 (8%) were elderly. Elderly patients were equally likely to be male (70% vs 83%, P = 0.06), but were significantly less likely to present with GCS ≤8 (20% vs 45%, P < 0.01) despite a significantly higher incidence of severe head trauma (AIS head >3 [53% vs 32%, P = 0.02]). There was no difference in median blood products transfused within the first 24 hours (23 vs 22 units, P = 0.95). Overall mortality was 51%, higher in elderly patients (73% vs 49%, P < 0.01), with shorter time to death (median 14 vs 34 days, P < 0.01). Adjusted Cox regression confirmed significantly higher adjusted mortality in the elderly (HR 1.25, P = 0.04). Conclusion Elderly trauma patients requiring MT experience earlier and significantly higher mortality than younger patients, highlighting the need for improved risk stratification and tailored resuscitation strategies.