Association between time to transfusion and outcomes in patients with traumatic haemorrhagic shock: an analysis of a nationwide trauma registry in Japan.

PURPOSE: To investigate the association of in-hospital time to transfusion on outcomes of patients with traumatic haemorrhagic shock.

METHODS

Using data from the Japan Trauma Data Bank (January 2019-December 2023), we identified adult patients (aged ≥ 18 years) with haemorrhagic shock following trauma (systolic blood pressure < 90 mmHg; shock index ≥ 1.0 upon hospital arrival) and received ≥ 10 units red blood cells within 24 h of injury. We excluded patients transferred from or to other hospitals after emergency treatment, with burn injuries or cardiac arrest, without transfusion time records, and with first transfusion > 60 min after hospital arrival. Mixed-effect multivariable logistic regression estimated the association between time to transfusion for in-hospital mortality, adjusting for patient characteristics, comorbidities, and injury severity. Heterogeneity in the association between transfusion timing and mortality was assessed through nine subgroup analyses.

RESULTS

Overall, 698 patients (median age 59 years, 66.2% male) from 132 hospitals were analysed, of whom 265 (38.0%) died during hospitalisation. Mean time to transfusion varied from 4 to 58 min across hospitals. A positive association was observed between time to transfusion and in-hospital mortality. Each 1-min delay in transfusion initiation was associated with higher in-hospital mortality (adjusted odds ratio 1.015, 95% confidence interval 1.002-1.028). Subgroup analyses did not show statistically significant evidence of interaction between transfusion timing and subgroup variables.

CONCLUSION

Delayed transfusion initiation was significantly associated with higher in-hospital mortality in patients with traumatic haemorrhagic shock. Reducing in-hospital delays to transfusion may represent an important target for trauma care quality improvement.