Transfusion Futility Thresholds for Geriatric Trauma With or Without Concomitant Traumatic Brain Injury
Document Type
Article
Publication Date
11-5-2025
Publication Title
Journal of Trauma Nursing
Abstract
BACKGROUND: Geriatric trauma patients frequently require massive transfusion, yet clear guidelines on transfusion futility thresholds (TFTs) remain underdeveloped, particularly in patients with thoracoabdominal injuries and concomitant traumatic brain injury (TBI). OBJECTIVE: To investigate TFT in geriatric trauma patients with moderate-to-severe chest and/or abdominal injuries with or without TBI. METHODS: This retrospective cohort analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database from 2017 to 2021 investigated geriatric trauma patients (age ≥ 65) with moderate-severe abdominal (abbreviated injury score [AIS] abdomen ≥ 2) and/or chest (AIS chest ≥ 2) injuries with or without concomitant TBI. Outcomes included mortality, transfusion threshold, ventilation-free days, complications, and intensive care unit length of stay (ICU-LOS). RESULTS: There were 1,072 non-TBI and 289 TBI patients included in this analysis. The TFT was 12 units of packed red blood cells (pRBCs) among non-TBI patients and 6 units of pRBCs among TBI patients within 4 hr of arrival. Patients exceeding the TFT in both groups had significantly higher odds of 48-hr mortality (OR: 3.949, 95% CI: [2.270, 6.870], p < .001; OR: 6.426, 95% CI: [1.772, 23.311], p = .005). Non-TBI patients exceeding the TFT had higher odds of developing acute kidney injury (AKI) (OR: 2.606, 95% CI: [1.136, 5.980], p = .024), severe sepsis (OR: 6.146, 95% CI: [1.485, 25.445], p = .012), and a significantly longer ICU-LOS (B: 3.445, 95% CI: [0.903, 5.987], p = .008). CONCLUSION: Among geriatric trauma patients with abdominal and/or chest injuries with or without concomitant moderate-severe TBI, those exceeding the TFT had significantly higher odds of 48-hr mortality. Additionally, non-TBI patients exceeding the TFT had higher odds of severe sepsis and AKI. This study offers strong evidence for the establishment of massive transfusion guidelines specific to the geriatric population, particularly with or without TBI.
First Page
368
Last Page
377
PubMed ID
41061745
Volume
32
Issue
6
Rights
© 2025 Society of Trauma Nurses
Recommended Citation
Nunes, Nikita; Nasef, Hazem; Baum, Samuel; Chin, Brian; Amin, Quratualin; Patel, Heli; Zito, Tracy; and Elkbuli, Adel, "Transfusion Futility Thresholds for Geriatric Trauma With or Without Concomitant Traumatic Brain Injury" (2025). School of Medicine Faculty Publications. 4163.
https://digitalscholar.lsuhsc.edu/som_facpubs/4163
10.1097/JTN.0000000000000888