Mortality from trauma haemorrhage and opportunities for improvement in transfusion practice

Background:The aim of this study was to describe the prevalence, patterns of blood use and outcomesof major haemorrhage in trauma.

Methods: This was a prospective observational study from 22 hospitals in the UK, including both majortrauma centres and smaller trauma units. Eligible patients received at least 4 units of packed red bloodcells (PRBCs) in the rst 24 h of admission with activation of the massive haemorrhage protocol. Casenotes, transfusion charts, blood bank records and copies of prescription/theatre charts were accessedand reviewed centrally. Study outcomes were: use of blood components, critical care during hospital stay,and mortality at 24 h, 30 days and 1 year. Data were used to estimate the national trauma haemorrhageincidence.

Results: A total of 442 patients were identied during a median enrolment interval of 20 (range 7–24)months. Based on this, the national incidence of trauma haemorrhage was estimated to be 83 per million.The median age of patients in the study cohort was 38 years and 73⋅8 per cent were men. The incidence of major haemorrhage increased markedly in patients aged over 65 years. Thirty-six deaths within 24 h of admission occurred within the rst 3 h. At 24 h, 79 patients (17⋅9 per cent) had died, but mortality continued to rise even after discharge. Patients who received a cumulative ratio of fresh frozen plasma to PRBCs of at least 1 : 2 had lower rates of death than those who received a lower ratio. There were delays in administration of blood. Platelets and cryoprecipitate were either not given, or transfused well after initial resuscitation.Conclusion: There is a high burden of trauma haemorrhage that affects all age groups. Research isrequired to understand the reasons for death after the rst 24 h and barriers to timely transfusion support.