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. 2025 Sep 29.
doi: 10.1097/JTN.0000000000000888. Online ahead of print.

Transfusion Futility Thresholds for Geriatric Trauma With or Without Concomitant Traumatic Brain Injury

Nikita Nunes  1 , Hazem Nasef, Samuel Baum, Brian Chin, Quratualin Amin, Heli Patel, Tracy Zito, Adel Elkbuli
Affiliations

Transfusion Futility Thresholds for Geriatric Trauma With or Without Concomitant Traumatic Brain Injury

Nikita Nunes et al. J Trauma Nurs. .

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.

Keywords: Geriatric trauma; Massive transfusion; Transfusion futility threshold; Traumatic brain injury.

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Conflict of interest statement

The authors declare no conflicts of interest.

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