Predictors of Massive Transfusion in Patients With Hollow Organ Injury After Blunt Multiple Trauma: A Cohort of Blunt Bowel Mesenteric Injury

Background Massive transfusion (MT) is life‐saving for patients with exsanguination, especially after blunt abdominopelvic trauma, due to subtle manifestations. Blunt bowel mesenteric injuries (BBMIs), besides their potential risk of peritonitis, are still one of the few indications for emergency laparotomy for hemorrhagic shock in the era of nonoperative management. Early prediction of the need for MT defined as using ≥ 10 units of packed red blood cells (PRBCs) in 24 h and activation of the MT protocol (MTP) is a critical aspect in resuscitation. Current scoring systems predicting MT are usually laboratory data or hemodynamic status–dependent, which are limited by the time‐consuming and dynamic characteristics of trauma; thus, they seem to lack objectivity in patients with BBMI due to dramatic clinical deterioration. The present study aimed to determine the predictors of associated injuries contributing to the requirement for MT in patients who underwent surgical BBMI. Methods This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2022. The patients were divided based on the presence or absence of MT before emergency laparotomy. Associated injury parameters and bowel mesenteric injury characteristics were used in multivariate regression analysis to identify independent predictors of MT. Results A total of 163 adult patients with surgically proven BBMI were enrolled in the study. The overall patients with MT were 30.6% (50/163). Compared to the MT (−) group, BBMI patients receiving MT had worse clinical injury severity, vital signs, and prognosis; patients receiving MT had significant a lower initial hemoglobin level and higher percentages of receiving PRBC (11.15 mg/dL vs. 13.10 mg/dL, p < 0.001 and 47% vs. 42%, p < 0.001) and required more volume of PRBC at emergency department (ED) (5.5 units vs. 0 units, p < 0.001) as compared to the MT (−) group. Besides, patients with MT administered more amounts of PRBC within 24 h and at operation room in comparison with patients without MT (16 units vs. 2 units, p < 0.001 and 8 units vs. 0 units, p < 0.001). Patients with MT involved with more isolated mesenteric injury or combined injury and had both higher complications and overall mortality rates (94% vs. 55.8%, p < 0.001 and 32% vs. 4.4%, p < 0.001). In multivariate analysis, the presence of traumatic brain injury (TBI) (odds ratio OR = 6.7, 95% confidence intervals CIs: 1.66–27.02) and pelvic fracture (OR = 6.01, 95% CIs = 1.45–24.89) was identified as an independent predictor of MT after adjusting for confounding factors. Conclusions For patients with BBMI, one‐third require MT prior to laparotomy, necessitating early activation of the MTP. When BBMI patients present with hemodynamic instability or higher injury severity, particularly in the presence of concomitant TBI or pelvic fractures, trauma surgeons should initiate more aggressive resuscitation to prevent therapeutic delays.