Utilization of blood in patients with gunshot wounds: A Canadian single‐center experience

BACKGROUND: Blood product utilization among gunshot wound (GSW) victims has not been characterized in Canada. This study describes transfusion requirements in GSW patients treated at a major Canadian Level-1 urban trauma center. STUDY DESIGN AND METHODS: A retrospective review of a hospital trauma registry in Toronto, Canada, identified GSW patients between 2017 and 2021. Patients under 16, those refusing transfusions, and patients with Absent Vital Signs for whom resuscitation was not initiated were excluded. Total and component-specific transfusions of red blood cells (RBC), plasma, and platelets were analyzed across hospital stay. RESULTS: Of 5452 trauma team activations, 5% were GSWs (n = 275; 91.3% male, n = 251; median age 26; overall mortality 14.9%, n = 41). Overall, 77 patients (28%) received 1134 units of blood components while 198 patients (72%) did not require any transfusions. Among those who required transfusions, the average number of blood product units (RBC, plasma, and platelets combined) per patient was 14.47. Transfusions included 716 RBC units, 344 plasma units, and 74 platelet pools. Consumption was markedly skewed: 18 patients (6.5%) who required at least 10 units consumed 70.5% of RBCs, 3.3% (n = 9) received 72.7% of plasma, and 1.1% (n = 3) used 59.5% of platelets. DISCUSSION: In this 5-year review, although GSWs account for a minority of trauma activations, they exert a disproportionate demand on blood inventory, driven heavily by an extreme minority of severely injured patients. Increasing gun violence may further strain the blood supply and recognition of this concentrated utilization pattern is essential for blood bank inventory preparedness, clinical care pathways, and injury prevention strategies.