Neurological outcome and mortality in polytrauma patients with severe traumatic brain injury and massive transfusion protocol.

OBJECTIVE

The aim of this study was to evaluate neurological outcomes and mortality in polytrauma patients with severe traumatic brain injury who were included in a massive transfusion protocol compared to those who were not.

METHODS

Retrospective analysis of adult traffic accident with blunt head trauma and severe traumatic brain injury between 2013 and 2018. Inclusion criteria: Glasgow Coma Scale score≤8, Abbreviated Injury Scale score≥3, Injury Severity Score≥16. Patients were divided into two groups: those who received massive transfusion protocol (massive transfusion protocol group) and those who did not (No massive transfusion protocol group). Data collected included demographics, accident type, severity scores, serum lactate, and base excess. Neurological outcomes were assessed using the modified Rankin Scale. Mortality and hospital length of stay were recorded.

RESULTS

77 patients met the inclusion criteria (massive transfusion protocol group: n=26 [33.8%]; No massive transfusion protocol group: n=51 [66.2%]). Most patients were young males involved in motorcycle accidents. Trauma scores, lactate, and base excess were similar between groups. The mean modified Rankin Scale score at discharge was lower in the massive transfusion protocol group (massive transfusion protocol: 4.65 vs. No massive transfusion protocol: 5.41; p=0.0313), indicating better neurological outcomes. Among surviving patients, the distribution of non-fatal modified Rankin Scale categories was similar between groups. Mortality (modified Rankin Scale 6) was significantly lower in the massive transfusion protocol group (57.7%) compared to the No massive transfusion protocol group (80.4%; p=0.007). Hospital length of stay in days was similar in both groups.

CONCLUSION

Inclusion in a massive transfusion protocol was associated with improved neurological outcomes and lower mortality in polytrauma patients with severe traumatic brain injury.