Balanced Component and Whole-Blood Transfusion Practices in US Trauma Centers
Main finding · Balanced component and WB transfusionResult — go to the resultAdjusted odds ratio 5.33 95% CI 4.88–5.81Authors' conclusion
In this retrospective cohort study of trauma patients at risk of hemorrhagic shock, the use of balanced component and WB use increased from 2018 to 2024, reflecting increasing WB adoption. Substantial between-hospital variation persisted.
Study context
- Population
- Adult trauma patients in hemorrhagic shock receiving blood transfusion within 4 hours of arrival, US Trauma Quality Improvement Program (2018–2024)
- Participants
- 71,997 patients · 650 trauma centers
- Exposure
- Trends, between-hospital variation and patient and hospital factors associated with balanced component and whole blood (WB) transfusion
- Outcome
- Balanced component and WB use (standardized plasma:RBC and platelet:RBC ratios or receipt of WB)
- Follow-up
- Within 4 hours of arrival
Methodological detailsmultilevel mixed-effects logistic regression, multicentre registry
- Multilevel mixed-effects logistic regression
- Multicentre registry
Main finding
Balanced component and WB transfusion
Adjusted odds ratio
5.33
95% CI 4.88–5.81
Events by group
2024 vs 2018
aOR 5.33 (95% CI 4.88–5.81)
As reported in the abstract
- Hospital-level differences accounted for 24% of variation (intraclass correlation coefficient)
- 0.24 (95% CI, 0.21-0.26)
Observational data: associations, not effects.
Further findings
Factors associated with balanced component and WB use
- Male sex, helicopter transport and treatment at larger hospitals associated with higher odds
- Major hemorrhage control surgery and severe torso injuries negatively associated, despite higher total transfusion volumes
Original publication
Balanced Component and Whole-Blood Transfusion Practices in US Trauma Centers. JAMA Netw Open. Published 1 September 2026. doi:10.
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