Use of Whole Blood for Trauma Laparotomy More Common in Low-Resource Settings

Blood component therapy is more common in high-resource settings compared with lower-resource settings, with progressively higher use in middle- and upper-resource settings, according to secondary results of an international multicenter study of transfusion in trauma laparotomy published in eClinicalMedicine. The results also demonstrated that whole blood transfusion was more than twice as common in lower-resource settings compared with higher-resource settings.

Trauma is associated with 4.4 million deaths worldwide every year and high rates of associated morbidity and disability. In addition, 10% of trauma patients sustain an abdominal injury; in these patients, hemorrhage remains the leading cause of mortality. Trauma laparotomy can be a life-saving intervention.

The researchers compared pre-operative blood product usage, which was recorded from time of injury until index procedure for trauma laparotomy. Countries were stratified by Human Development Index (HDI).

The Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) study was conducted at 187 hospital centers in 51 countries. The study included patients (any age) with a blunt or penetrating traumatic injury who underwent a laparotomy within the first five days. Patients were followed up until discharge, death or 30 days post-operatively (if still hospitalized).

“Our findings show significant disparity in the usage of pre-operative blood products for trauma patients globally. With ongoing equipoise regarding the optimum balance of blood products for pre-operative resuscitation in trauma, this work informs future research to support the development of global guidelines for blood transfusion practices in trauma and highlights the need for reciprocal learning across income settings,” the authors wrote.