Predictors of Massive Transfusion in Adult Blunt Trauma Patients: Analysis of a Nationwide Trauma Registry in Korea

BACKGROUND: Massive transfusion (MT) is critical for trauma patients with severe hemorrhage; however, predicting the need for MT upon hospital arrival remains challenging. Herein, we aimed to identify predictors of MT in adult blunt trauma patients using data from the Korean Trauma Data Bank (KTDB), a nationwide trauma registry in Korea. METHODS: We retrospectively analyzed data from patients registered in the KTDB from 2017 to 2021. Adult blunt trauma patients who received packed red blood cell (pRBC) transfusion within 24 hours of arrival were included. We divided the patients into the MT and non-MT groups, with MT defined as the administration of ≥ 10 units of pRBCs within 24 hours. We compared the characteristics of the two groups and performed multivariable logistic regression analysis to identify significant predictors of MT, using multiple imputation to address missing data. RESULTS: Among 12,145 patients registered in the KTDB, 2,098 (17.3%) received MT. Compared with the non-MT group, the MT group exhibited lower initial systolic blood pressure, lower Glasgow Coma Scale (GCS) scores, and higher heart rates compared to the non-MT group. Multivariable logistic regression analysis identified systolic blood pressure ≤ 90 mmHg (adjusted odds ratio [aOR], 2.34), heart rate ≥ 120 bpm (aOR, 2.15), respiratory rate < 10 or > 29 breaths per minute (aOR, 2.16), GCS < 13 (aOR, 2.45), and a positive Focused Assessment with Sonography for Trauma (FAST) result (aOR, 2.35) as significant predictors of MT upon arrival. CONCLUSION: We identified initial systolic blood pressure, heart rate, respiratory rate, GCS, and FAST results as significant predictors of MT in adult blunt trauma patients. These predictors may aid in the development of a Korea-specific MT prediction model, contributing to the timely activation of MT protocols and optimization of blood product utilization.