Twenty-four-hour packed red blood cell requirement is the strongest independent prognostic marker of mortality in ED trauma patients

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Injury severity score, serum lactate, and shock index help the physician determine the severity of injuries present and have been shown to relate to mortality. We sought to determine if an increasing amount of packed red blood cells (PRBCs) given in the first 24 hours of admission is an independent predictor of mortality and how it compares to other validated markers.


A 6-year retrospective, observational study of adult trauma patients was conducted at a level 1 trauma center. Charts were reviewed for demographic data, amount of PRBC received in the first 24 hours, injury severity score, shock index, and lactate levels. Subgroups were used to determine if each variable was an independent predictor of mortality. Correlation coefficients and linear regression were used to determine the strength of correlation between each variable and mortality.


One hundred fifty-seven patients met criteria over a 6-year period. The average age was 28 years, 93% were male, and 86% had penetrating injuries. The average injury severity score, serum lactate, and shock index were 18, 6.1, and 0.9, respectively. The average amount of blood given was 6.7 U.


Twenty-four-hour PRBC requirement is both a novel independent predictor of and has the greatest correlation to mortality in adult trauma patients when compared to injury severity score, shock index, and serum lactate.

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