Effect of Race on the Association Between Whole Blood Transfusion and Mortality in Bleeding Trauma Patients

INTRODUCTION: Preliminary studies have demonstrated a mortality benefit of whole blood (WB) vs blood component therapy in trauma resuscitation, but WB remains a scarce product in trauma centers and necessitates appropriate resource allocation. The purpose of this study was to evaluate for disparities in WB use based on race and to determine whether this affected mortality. METHODS: A prospective MCT involving 14 trauma centers was performed. All trauma patients who received blood transfusions as part of their initial resuscitation were included. A multivariable logistic regression model was used to measure the association between WB and mortality, controlling for Injury Severity Score, shock index, mechanism of injury, transfusion volume, and center. The effect of race (non-Black vs Black) on WB use and mortality was explored. RESULTS: Of 1,621 patients (age 40 years, 83% male, 42% Black), 1,178 (73%) patients received at least 1 unit of WB. When controlling for Injury Severity Score, shock index, mechanism of injury, transfusion volume, and center, Black patients were significantly less likely to receive WB than were non-Black patients (Table). Race modified the association between blood transfusion type and mortality. In multivariable logistic regression, we found that among patients who did not get WB, Black patients were more likely to die compared with non-Black patients (odds ratio 2.12, 95% CI 1.42 to 3.21).TableCONCLUSION: Black trauma patients were less likely to receive WB vs blood component therapy during initial resuscitation for hemorrhage. Race modified the risk of mortality, making Black patients who did not receive WB more likely to die vs non-Black patients.