Blood Loss and Transfusion of Gunshot Wound Victims
Following another weekend of mass shooting in the United States, I thought it might be poignant to review the recent findings of a paper published by researchers at Johns Hopkins. The authors analyzed 23,422 trauma patients that presented to their Level 1 trauma center between 2005 to 2017 and compared patients with gunshot wounds (11.4%of trauma patients) to those with non-gunshot would traumatic injuries.
Patients with gunshot wounds (GSW) were 5 times more likely to require transfusion and were transfused with 10 times more blood components compared to non-GSW patients. The non-GSW cohort included penetrating trauma and blunt force trauma. Although GSW represented only 11% of trauma cases, they accounted for more than 50% of transfusions.
Victims of GSW were 8 times as likely to die compared to victims of non-gunshot, penetrating trauma and 14 times as likely to die compared to trauma patients overall, including blunt force trauma. GSW accounted for two-thirds of the deaths.
In this study, the overall mortality was 24% in all GSW victims and 33% in transfused GSW victims. Nationwide, mortality rates for hospitalized GSW victims have been estimated to be 8.3%. The lethality of GSW injuries has recently increased to the extent that even the best Level 1 trauma centers experience a relatively high mortality rate.
Hospitals with Level 1 trauma centers must have excellent transfusion services that can rapidly deliver high volumes of RBCs, platelets, plasma and cryoprecipitate at short notice. Massive transfusion protocols save lives in hemorrhaging trauma patients. Of course, hospitals and transfusion services depend on an ample blood supply and altruistic blood donors.
Reference
DeMario VM et al. Blood utilization and mortality in victims of gun violence. Transfusion 2018;58:23426-2334.
Transfusion. 2018 Oct;58(10):2326-2334.)
