Clinical Outcomes Following Component Therapy Only Versus Whole Blood Plus Component Versus Whole Blood Only in Geriatric Trauma Patients With Isolated Chest or Abdominal Injuries With or Without Traumatic Brain Injury

Hazem Nasef; Nikita Nunes Espat; Brian Chin; Alaina Werling; Quratulain Amin; Caitlin Tweedie; William S Havron; Chadwick Smith; Adel Elkbuli

doi:10.1016/j.jss.2024.11.046

Clinical Outcomes Following Component Therapy Only Versus Whole Blood Plus Component Versus Whole Blood Only in Geriatric Trauma Patients With Isolated Chest or Abdominal Injuries With or Without Traumatic Brain Injury

J Surg Res. 2024 Dec 28:305:337-348. doi: 10.1016/j.jss.2024.11.046. Online ahead of print.

Authors

Hazem Nasef¹, Nikita Nunes Espat¹, Brian Chin², Alaina Werling¹, Quratulain Amin¹, Caitlin Tweedie³, William S Havron⁴, Chadwick Smith⁴, Adel Elkbuli⁵

Affiliations

¹ NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida.
² University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii.
³ Department of Internal Medicine, Orlando Regional Medical Center, Orlando, Florida.
⁴ Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
⁵ Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida. Electronic address: [email protected].

PMID: 39733471
DOI: 10.1016/j.jss.2024.11.046

Abstract

Introduction: This study aims to evaluate clinical outcomes in geriatric trauma patients with isolated chest or abdominal injuries with or without traumatic brain injury (TBI) receiving whole blood (WB), component (COMP), or WB and component therapy (WB + COMP).

Methods: This retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program Participant Use File dataset from 2017 to 2021 evaluated geriatric (age ≥65) trauma patients with moderate-to-severe isolated chest (abbreviated injury scale (AIS) chest ≥2) or abdominal (AIS abdomen ≥2) injuries with or without TBI (AIS head ≥2) receiving WB, COMP, or WB + COMP. Outcomes included emergency department and 24-h mortality, blood product volume (mL) at 4 hs, and intensive care unit-length of stay.

Results: Among non-TBI patients with isolated chest injuries, COMP patients required significantly less plasma (regression coefficient β = -428 mL, 95% confidence interval (CI): 604 mL-249 mL, P < 0.001), and had 48% lower odds of 24-h mortality than WB patients (odds ratio = 0.519, 95% CI: 0.285-0.946, P = 0.032). Among TBI patients with isolated chest injuries, there was no significant association between receiving COMP and plasma volume requirement (β = -166.227, 95% CI: -366.370 to 33.916, P = 0.104) or 24-h mortality (odds ratio = 0.606, 95% CI: 0.301-1.220, P = 0.161) when compared to WB patients.

Conclusions: Compared to WB or WB + COMP, COMP therapy significantly reduced transfusion requirements in non-TBI patients. Additionally, COMP therapy was associated with lower 24-h mortality in geriatric patients with isolated chest injuries. TBI patients with isolated chest injuries had no significant differences in clinical outcomes. Further research is warranted to explore the potential benefits of COMP therapy on mortality outcomes in TBI patients.

Keywords: Component therapy; Geriatric trauma; Massive transfusion; Trauma outcomes; Traumatic brain injury; Whole blood and component therapy; Whole blood therapy.