Factors affecting decision making of physicians to start prehospital blood product transfusion in blunt trauma patients – a cohort study of Helsinki Trauma Registry.

Abstract

Abstract Background: Prehospital blood product use is increasing as a treatment for bleeding trauma patients. Triggers for starting transfusion in the field are less studied. We aimed to analyze factors affecting the decision of physicians to start prehospital blood product transfusion in blunt adult trauma patients. Methods: Originally prospectively collected data from the Helsinki Trauma Registry from adult blunt trauma patients between March 2016 and July 2021 were retrospectively analyzed. We compared two groups: one with blood products available in the field and one without. Univariate analysis for the identification of predictive factors and multivariate regression analysis for their importance as predictivefactors forthe initiation of prehospital blood product transfusion wereapplied. Results: There were 1652 patients registered in the database. A total of 556 of them were treated by a physician-level prehospital emergency care unit. Prehospital blood product transfusion (red blood cells and/or plasma) was started in 19.8% of the patients when available. We identified three statistically highly important clinical triggers for starting prehospital blood transfusion: high crystalloid volume need, shock index ≥0.9, and need for prehospital pleural decompression. No effect of prehospital blood product transfusion on patient outcome was found. Conclusions: Prehospital blood product transfusion in blunt adult trauma patients is initiated in approximately 20%of the patients in Southern Finland. High crystalloid need, shock index ≥0.9 and prehospital pleural decompression are associated with the initiation of prehospital blood product transfusion, probably reflecting patients at high risk for bleeding. Trial registration:HUS/234/2020