Gunshot
victims need much more blood - more likely to die than other trauma
patients
Johns Hopkins Medicine
In a new analysis of
data submitted to Maryland's state trauma registry from 2005 to 2017, Johns
Hopkins Medicine researchers found that gunshot victims are approximately five
times more likely to require blood transfusions, they require 10 times more blood
units and are 14 times more likely to die than people seriously injured by
motor vehicles, non-gun assaults, falls or stabs.
A report of the
findings of the study, designed to better understand demands for and shortages
of blood transfusion products, was published Sept. 13 in Transfusion.
"Blood products
cost a lot, come with a lot of risks for those transfused, and are scarce, so
understanding what kinds of trauma are most likely to require more of them can
help hospitals improve outcomes for trauma victims," says Steven Frank,
M.D., professor of anesthesiology and critical care medicine at The Johns
Hopkins University and the study's corresponding author.
To better understand the extent of blood use and associated costs for gunshot wound (GSW) victims, Frank and colleagues analyzed data from 23,422 Johns Hopkins Hospital trauma patients entered into the Maryland trauma registry from 2005 to 2017.
The average age for
GSW patients was 27 and the average for non-GSW patients was 38. Males made up
the majority of both types of patients -- 2,497 of 2,672 (93.45 percent) GSW
patients and 13,954 of 20,750 (67.3 percent) of non-GSW patients were male.
Of all patients in the
trauma registry, 2,672 (11.4 percent) had GSW injuries and 20,750 (88.6
percent) had non-GSW trauma injuries resulting from motor vehicle, nongun
assaults, falls or stabs. GSW patients were five times more likely to require a
blood transfusion (538 of 2,672, or 20.1 percent) compared to non-GSW patients
(798 of 20,750, or 3.9 percent).
When comparing all
patients, the researchers found that GSW patients needed 10 times more units of
blood than non-GSW patients (3.3 units versus 0.31 units for non-GSW patients).
Frank and colleagues
also found that GSW patients were more likely to die in the emergency
department (69 of 2,672, or 2.6 percent) than non-GSW patients (17 of 20,750,
or 0.08 percent). Overall, GSW patients were about 14 times more likely to die
(653 of 2,672, or 24.4 percent) than non-GSW patients (352 of 20,750, or 1.7
percent).
"The most likely
explanation for these findings is the dramatic degree of injury severity in
gunshot victims compared to all other types of trauma, including stab
wounds," says Frank.
In their analysis of
cost for blood transfusions, the research team compared two types of costs:
acquisition costs, or the cost of the unit itself ($200 per unit of red blood
cells, $500 per unit of platelets, $50 per unit of plasma and $250 per dose of
cryoprecipitate), and activity based costs, which are acquisition costs plus a
fourfold increase for overhead that includes storage, viral testing, transport,
compatibility testing and the cost of giving the blood to the patient.
Although overall, only
11.4 percent of all trauma patients had GSW injuries, more money was spent on
blood for these patients than for all non-GSW trauma patients combined:
$1,523,450 for GSW patients versus $1,140,250 for non-GSW patients in
acquisition costs, and $6,093,800 versus $4,561,000 for non-GSW activity costs.
"For emergency
preparedness purposes, hospitals that treat trauma need to have a sufficient
amount of blood in the bank in order to treat patients coming in with gunshot
wounds," says Frank.
In the United States
each year, over 116,000 people are injured and over 38,000 people die from
gun-related injuries.
Other authors on this
paper include Vincent DeMario, Robert Sikorski, David Efron, Mara Serbanescu,
Rica Buchanan, Eric Wang, Mereze Visagie, Eric Gehrie, Maraiuxi Manukyan, Kathy
Noll, Ken K.H. Lee and Paul Ness of Johns Hopkins Medicine.