(P07) Use of Whole Blood at a Level II Trauma Center in Patients Presenting in Hemorrhagic Shock: Reducing Hospital Length of Stay

Objectives: The present study is a prospective observational study investigating the effect of emergent resuscitation with whole blood on hospital length of stay. We hypothesized that using whole blood in the initial resuscitation of trauma patients in hemorrhagic shock would result in decreased hospital length of stay.

Background: Hospital length of stay is a widely accepted healthcare quality metric (1). When the demand for hospital beds exceeds the supply, the effects are felt throughout the hospital, including the ED, resulting in ED overcrowding and boarding (2). Over the last few years and through the post-COVID era, ED boarding has become the norm and not the exception (3,4). Therefore, any interventions that have the potential to reduce hospital length of stay will likely impact ED wait times, and ideally reduce ED boarding. Several studies have indicated that ED crowding and boarding are associated with worse clinical outcomes (5-10).

Methods: Study Setting: Memorial Hospital is a verified level 2 Trauma Center in South Bend, Indiana, serving the communities of Northern Indiana and Southern Michigan.

Patient population: Patients 18 years of age and older who met trauma activation criteria presenting in hemorrhagic shock with evidence of active bleeding requiring emergent blood product transfusion were included in the study.


Design: This is a single center prospective cohort study in which whole blood, pRBCs, fresh frozen plasma, liquid plasma, platelets, and/or cryoprecipitate were used early in the resuscitation of injured patients presenting with evidence of hemorrhagic shock and predicted to require and receive a large volume infusion of blood products. This study was not a blinded trial. Patients were not randomized.

Outcome Measure: A descriptive summary was prepared using counts and proportions for categorical variables and mean and standard deviations for continuous variables. The primary outcome of interest was the length of hospital stay. Multiple linear regression was used to determine the association between receipt of whole blood on hospital duration of stay after adjusting for injury severity score and earliest calculated shock index.

Results: Study period was 08/30/2021 through 11/13/2022. During that time period, 159 patients meeting trauma activation criteria were eligible to be enrolled. These patients had a 911 or 912 activation and received emergency release blood products. 119 patients survived initial resuscitation and subsequent hospitalization and were discharged after treatment. They were included in our final analysis. Of these, 50 (42.0%) received whole blood. Average patient age was 43. The majority of patients were male (72.3%). The injury mechanism for most patients was motor vehicle crash (48.7%) (Table 1).

Hospital duration of stay was 5.31 days shorter among patients who received whole blood compared to patients who did not receive whole blood (Table 2). After removing one high valued outlier, duration of stay was 3.09 days shorter among patients who received whole blood compared to patients who did not receive whole blood (Table 3). Although this association was not statistically significant, the strength of the effect we present is notable. Injury severity score was significantly associated with hospital length of stay in our sample (p < 0.0001).

Conclusions: This study provides evidence of a potential relationship between initial resuscitation with whole blood and length of stay. This finding is of importance in the wake of the COVID-19 pandemic, where resource constraints have become more salient (4). Overcrowding is a barrier impacting patient care, both hospital-wide and in the ED (3). ED boarding has known negative consequences. Decreasing length of stay can decrease healthcare costs, improve satisfaction for both patients and healthcare workers, and potentially reduce the number of hospital-acquired patient complications. This study was limited by a smaller sample size; enrolling additional patients would improve precision of estimates.

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10. Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments [published correction appears in Med J Aust. 2006 Jun 19;184(12):616]. Med J Aust. 2006;184(5):208-212. doi:10.5694/j.1326-5377.2006.tb00416.x

Funding (Optional): n/a