(P-PB-9) Blood transfusion in injured older adults: a retrospective cohort study assessing equity of trauma care in older patients

Background: Older adults are an increasing proportion of acute trauma care and transfusion but the specific interactions of increasing age with blood product use are unclear.  We asked how increasing age interacts with acute transfusion and in-hospital mortality among older injured adults at our large regional US Level I trauma center and if there is evidence of problems with equity of care in older patients.

Study

Design/Methods:

Methods: Trauma registry demographic and injury data were linked to transfusion service records for all acute trauma patients treated at our center from 2011 to 2022. Subsets of patients aged ≥55 were identified by age decade and trends assessed with categorical and multivariable regression methods using statistical software (SAS), p < 0.01. Equity was assessed as equivalent transfusion intensity measured in the first 4 hours of care for equivalent injury across age decades and displayed using R.

Results/Findings:

Results: Of 73,645 patients, 25,409 (34.5%) were aged ≥55 and 15,650 (21.2%) were ≥65 years. Relative proportions of women and transfer patients increased across the progressive older age groups, but overall, patients ≥55 were more likely to receive any blood (24% vs 15.4% in those < 55years) and, despite roughly equivalent injury severity, to be transfused in the first four hours and 24 hours of care (respectively, 9.5 vs 7.0% and 15.0 vs 9.0%), more likely to die in hospital (7.4 vs 2.9%), but less likely urgently (≥3 units first hour, 1.9 vs 2.7%) or massive resuscitation (0.6 vs 1.1%). These effects concentrated among those ≥65 years with blunt, usually fall-related, injury and increased with increasing age, but individual transfusion volume was driven by injury severity, not age as shown in Figure 1

Conclusions:

Conclusions: In our trauma resuscitation practice, patients ≥55 years are more likely to receive blood products than younger patients, but resuscitation volume appears to be based on injury severity without regard to age in the early phase of care.