Predictors of massive transfusion in patients with hollow organ injury after blunt abdominal trauma: a cohort of blunt bowel mesenteric injury

Background Massive transfusion (MT) is life-saving for patients with exsanguination, especially after blunt abdominopelvic trauma, due to subtle manifestations. Blunt bowel mesenteric injuries (BBMI), besides their potential risk of peritonitis, are still one of the few indications for emergency laparotomy for hemorrhagic shock in the era of non-operative management. Early prediction of the necessity for MT is a critical point in resuscitation. Methods This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2022, and included 163 adult patients with surgically proven BBMI. The patients were divided based on the presence or absence of MT before emergency laparotomy. Associated injury parameters and bowel mesenteric injury characteristics were used in multivariate regression analysis to identify independent predictors of MT. Results The MT (+) group included 30.6% of patients (n = 50). Compared to the MT (-) group, BBMI patients receiving MT had worse clinical injury severity, vital signs, and prognosis; received more units of blood products and more invasive treatments; had more isolated mesenteric injury or combined injury; and had both higher morbidity and mortality rates (94% vs. 55.8%, p  < 0.001 and 32% vs. 4.4%, p  < 0.001). In multivariate analysis, the presence of traumatic brain injury (TBI) (odds ratio [OR] = 6.7, 95% confidence intervals [CIs]: 1.66–27.02) and pelvic fracture (OR = 6.01, 95% CIs = 1.45–24.89) was identified as an independent predictor of MT after adjusting for confounding factors. Conclusions Almost half the patients with BBMI present with shock episodes, and one-third of them require MT before laparotomy, reflecting the critical status for their exsanguination. Patients with associated TBI and pelvic fracture injuries are at increased risk of MT and need to be prioritized for resuscitation.