Predictors of mortality available at emergency department arrival in massively transfused trauma patients without severe TBI: A single-center retrospective cohort study
- 1Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
Abstract
Trauma patients requiring massive transfusion have mortality exceeding 40%, yet early risk-stratification tools for this population remain limited. We evaluated readily available predictors of mortality in massively transfused trauma patients, excluding those with severe traumatic brain injury (TBI) to focus on a hemorrhage-predominant cohort. This single-center retrospective cohort study included trauma patients who received massive transfusion at Chonnam National University Hospital between January 2018 and December 2023. Patients with severe TBI (Head Abbreviated Injury Scale [AIS] ≥ 4) were excluded. Three sequential multivariate logistic regression models were constructed: a primary model using variables available at emergency department (ED) arrival, a secondary model adding laboratory values, and an exploratory model incorporating early transfusion course variables. Of 172 massively transfused trauma patients, 124 met inclusion criteria (Head AIS < 4). Overall mortality was 41.1% (51/124), with 24-hour mortality of 23.7% (28/118). The Glasgow Coma Scale (GCS) was the strongest independent predictor across all models (OR = 0.77–0.79 per point, p < 0.001). In the primary ED arrival model (AUC = 0.770), GCS was the sole significant predictor; GCS alone achieved a comparable AUC of 0.771. The exploratory model incorporating transfusion variables achieved the highest discrimination (AUC = 0.828). All models showed adequate calibration (Hosmer–Lemeshow p > 0.05). Mortality decreased with longer time-to-first-transfusion (54.5% for ≤15 min vs. 23.7% for >60 min, trend p = 0.007), reflecting confounding by indication. In massively transfused trauma patients without severe TBI, GCS assessed at ED arrival is the single most informative predictor of mortality, enabling risk stratification before laboratory results become available. Metabolic acidosis markers and coagulopathy were strongly associated with mortality on univariate analysis but added no independent predictive value beyond GCS. Time-to-first-transfusion appeared to reflect hemorrhage acuity rather than a modifiable prognostic factor.
Related
- On-Device ECG and Vital-Sign Prediction of 24-Hour Mortality and Unplanned ICU Admission in Emergency Department Patients: A Retrospective Evaluation of MEDI-AI
- Survival Status and Predictors of Mortality Among Women With Breast Cancer in Southern Ethiopia: A Retrospective Cohort Study
- Prehospital qSOFA Is Associated with 30-Day Mortality Within Emergency Department Triage Strata in Ambulance-Transported Adults with Suspected Infection: An Exploratory Three-Year Retrospective Cohort Study
- Early Mortality in Patients with Biopsy-Only Glioblastoma: Clinical, Radiological and Molecular Predictors from a Retrospective Cohort
- Clinical Characteristics and Mortality Predictors of Group B Streptococcus Bacteremia in Adults: A Multicenter Retrospective Cohort Study in Japan, 2015-2024.
BibTeX
@article{jo2026predictors,
title = {{Predictors of mortality available at emergency department arrival in massively transfused trauma patients without severe TBI: A single-center retrospective cohort study}},
author = {Younggoun Jo and Yunchul Park and Euisung Jeong and Hyunseok Jang and Hyo-Sin Kim},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359963},
url = {https://doi.org/10.1371/journal.pone.0359963},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors of mortality available at emergency department arrival in massively transfused trauma patients without severe TBI: A single-center retrospective cohort study
AU - Younggoun Jo
AU - Yunchul Park
AU - Euisung Jeong
AU - Hyunseok Jang
AU - Hyo-Sin Kim
PY - 2026
DA - 2026/10/01
JO - PLOS One
DO - 10.1371/journal.pone.0359963
UR - https://doi.org/10.1371/journal.pone.0359963
AB - Trauma patients requiring massive transfusion have mortality exceeding 40%, yet early risk-stratification tools for this population remain limited. We evaluated readily available predictors of mortality in massively transfused trauma patients, excluding those with severe traumatic brain injury (TBI) to focus on a hemorrhage-predominant cohort. This single-center retrospective cohort study included trauma patients who received massive transfusion at Chonnam National University Hospital between January 2018 and December 2023. Patients with severe TBI (Head Abbreviated Injury Scale [AIS] ≥ 4) were excluded. Three sequential multivariate logistic regression models were constructed: a primary model using variables available at emergency department (ED) arrival, a secondary model adding laboratory values, and an exploratory model incorporating early transfusion course variables. Of 172 massively transfused trauma patients, 124 met inclusion criteria (Head AIS < 4). Overall mortality was 41.1% (51/124), with 24-hour mortality of 23.7% (28/118). The Glasgow Coma Scale (GCS) was the strongest independent predictor across all models (OR = 0.77–0.79 per point, p < 0.001). In the primary ED arrival model (AUC = 0.770), GCS was the sole significant predictor; GCS alone achieved a comparable AUC of 0.771. The exploratory model incorporating transfusion variables achieved the highest discrimination (AUC = 0.828). All models showed adequate calibration (Hosmer–Lemeshow p > 0.05). Mortality decreased with longer time-to-first-transfusion (54.5% for ≤15 min vs. 23.7% for >60 min, trend p = 0.007), reflecting confounding by indication. In massively transfused trauma patients without severe TBI, GCS assessed at ED arrival is the single most informative predictor of mortality, enabling risk stratification before laboratory results become available. Metabolic acidosis markers and coagulopathy were strongly associated with mortality on univariate analysis but added no independent predictive value beyond GCS. Time-to-first-transfusion appeared to reflect hemorrhage acuity rather than a modifiable prognostic factor.
SN - 1932-6203
ER -