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 cutoff 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.

History of anticoagulant and antiplatelet therapy as a predictive factor for transfusion requirement in elderly trauma patients in intensive care: A retrospective registry–based cohort analysis

“…As mentioned above, injuries in the chest, abdomen, and pelvis result from high‐energy trauma, such as motor vehicle accidents and falls. High‐energy trauma is known to cause a higher ISS and more severe coagulopathy from extensive tissue damage, 10 , 12 and increase the transfusion demand 28 . Therefore, we conducted multivariate analysis by controlling for ISS and main injury sites, which did not demonstrate statistically significant effects with respect to preinjury medication use on the transfusion amount (Table 5).…”

“…High-energy trauma is known to cause a higher ISS and more severe coagulopathy from extensive tissue damage, 10,12 and increase the transfusion demand. 28 Therefore, we conducted multivariate analysis by controlling for ISS and main injury sites, which did not demonstrate statistically significant effects with respect to preinjury medication use on the transfusion amount ( Table 5). These results are probably attributable to the limitations of this study, although traumatic hemorrhage is mostly influenced by the energy applied, main injury sites, and injury severity; this needs to be validated in further studies.…”

Epidemiology of Accidental Injuries at Home and Related Risk Factors for Mortality among Older Adults in South Korea: A Retrospective Cohort Study

“…This study found that older adults presenting with injuries had approximately twice the odds of mortality if they received a blood transfusion compared with if they did not. Decreased physiologic function, comorbidities, and medications in older adults may be risk factors, and even small transfusions of blood products may increase adverse effects such as inflammatory marker levels, coagulopathy, immunosuppression, and the potential for infection [36]. In contrast, previous studies comparing blood loss and transfusion in critically ill older adult trauma patients with younger patients have reported that the possibility of massive transfusion should be considered in older adult patients, even if their initial assessment is unremarkable, and that liberal transfusion may result in better outcomes compared with restrictive transfusion strategies [37].…”

Narrative Review: Is There a Transfusion Cutoff Value After Which Nonsurvivability Is Inevitable in Trauma Patients Receiving Ultramassive Transfusion?

“…6,28,30,31 Age is one predictor of mortality that has been topic of interest in prior MT studies, with results suggesting older patients had higher mortality rates for a given volume of blood. [39][40][41] Guerrero et al 40 demonstrated that patients aged >65 years old receiving ≥5 units of blood had a statistically significant increased risk of mortality, and also noted that plasma transfusion increased mortality 3-fold. Wu et al 41 analyzed the effects of the number of transfused blood units on mortality outcomes in elderly trauma patients and demonstrated as patients received more units of RBC, the higher their risk of mortality when compared to their younger counterparts.…”