Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality

Michael David Cobler-Lichter; Khaled Abdul Jawad; D Dante Yeh; Roman Dudaryk; Franklin Dexter; Richard H Epstein

doi:10.1111/trf.18191

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Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality

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Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality

Michael David Cobler-Lichter, Khaled Abdul Jawad, D Dante Yeh, Roman Dudaryk, Franklin Dexter and Richard H Epstein

Transfusion (Philadelphia, Pa.), Vol.65(S1), pp.S146-S155

05/2025

DOI: 10.1111/trf.18191

PMCID: PMC12035978

PMID: 40091188

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Abstract

Studies in elective surgery report adverse outcomes with transfusion of a solitary unit of red blood cells (RBC). We quantified the effect of discretionary transfusion of one unit of blood in trauma patients with borderline transfusion indications. We hypothesized that transfusion of a discretionary unit of RBCs would increase complications. Admitted adults from the 2017-2021 American College of Surgeons Trauma Quality Improvement Program database were included if they had an injury severity score between 10 and 25 and a Glasgow Coma Scale >8: moderately to severely injured patients. Associations between single-unit RBC transfusion in the first 4 h (with no subsequent transfusion) and three primary outcomes (mortality, infection, thromboembolic event) were assessed using inverse probability-weighting propensity matching with regression adjustment. A total of 649,841 patients were included in the study. Approximately 4.2% received one unit of RBC. Propensity matching (with fractional weighting) for transfusion resulted in 307,840.7 cases and 342,000.3 controls. Transfusion of a solitary unit of RBC was independently associated with each outcome: mortality (adjusted odds ratio [aOR] 2.11, 95% CI 1.66-2.69), infection (aOR 3.92, 95% CI 2.91-5.27), and thromboembolic event (aOR 2.02, 95% CI 1.55-2.64). Transfusion of a single unit of RBC within the first 4 h of arrival in trauma patients with no subsequent transfusion during hospitalization was associated with an increased risk of mortality, infection, and a thromboembolic event. When weighing the decision to transfuse trauma patients with equivocal signs of hemorrhage, one needs to balance the potential harm against the likelihood that such transfusion is necessary.

Trauma

transfusion

outcomes

blood

Details

Title: Subtitle: Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality
Creators: Michael David Cobler-Lichter - University of Miami
Khaled Abdul Jawad - University of Pittsburgh Medical Center
D Dante Yeh - Denver Health Medical Center
Roman Dudaryk - University of Miami
Franklin Dexter - University of Iowa
Richard H Epstein - University of Miami
Resource Type: Journal article
Publication Details: Transfusion (Philadelphia, Pa.), Vol.65(S1), pp.S146-S155
DOI: 10.1111/trf.18191
PMID: 40091188
PMCID: PMC12035978
NLM abbreviation: Transfusion
ISSN: 0041-1132
eISSN: 1537-2995
Publisher: WILEY
Language: English
Electronic publication date: 03/16/2025
Date published: 05/2025
Academic Unit: Anesthesia
Record Identifier: 9984801836502771

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