AI Insight
This retrospective study of 124 massively transfused trauma patients without severe traumatic brain injury found that the Glasgow Coma Scale (GCS) score at emergency department arrival was the strongest independent predictor of mortality, which reached 41.1% overall. While metabolic acidosis markers and coagulopathy were associated with mortality in initial analysis, they provided no additional predictive value beyond GCS. Shorter time-to-first-transfusion correlated with higher mortality, but this reflected greater injury severity rather than a causal relationship.
Why it matters
The findings suggest that a simple neurological assessment (GCS) available immediately upon patient arrival can effectively stratify mortality risk in hemorrhaging trauma patients before laboratory results are available. This could help emergency departments make faster triage and resource allocation decisions for patients requiring massive transfusions.
Understand the Science
by Younggoun Jo, Yunchul Park, Euisung Jeong, Hyunseok Jang, Hyo-Sin Kim
Trauma patients requiring massive transfusion have mortality exceeding 40%, yet early risk-stratification tools for this population remain limited. We evaluated readily available predictors of mortality in massively transfused trauma patients, excluding those with severe traumatic brain injury (TBI) to focus on a hemorrhage-predominant cohort. This single-center retrospective cohort study included trauma patients who received massive transfusion at Chonnam National University Hospital between January 2018 and December 2023. Patients with severe TBI (Head Abbreviated Injury Scale [AIS] ≥ 4) were excluded. Three sequential multivariate logistic regression models were constructed: a primary model using variables available at emergency department (ED) arrival, a secondary model adding laboratory values, and an exploratory model incorporating early transfusion course variables. Of 172 massively transfused trauma patients, 124 met inclusion criteria (Head AIS < 4). Overall mortality was 41.1% (51/124), with 24-hour mortality of 23.7% (28/118). The Glasgow Coma Scale (GCS) was the strongest independent predictor across all models (OR = 0.77–0.79 per point, p 0.05). Mortality decreased with longer time-to-first-transfusion (54.5% for ≤15 min vs. 23.7% for >60 min, trend p = 0.007), reflecting confounding by indication. In massively transfused trauma patients without severe TBI, GCS assessed at ED arrival is the single most informative predictor of mortality, enabling risk stratification before laboratory results become available. Metabolic acidosis markers and coagulopathy were strongly associated with mortality on univariate analysis but added no independent predictive value beyond GCS. Time-to-first-transfusion appeared to reflect hemorrhage acuity rather than a modifiable prognostic factor.