(P-TS-116) Statistically Significant Differences Observed Between Mean Pre-Transfusion Lab Values Associated with RBC and SDP Transfusions at Trauma Centers and Non-Trauma Centers

Background/Case Studies: Our system is composed of 6 trauma centers (TC) and 5 non-trauma centers (NTC). A hemorrhaging patient requiring MTP activation can occur at any hospital. Despite having a standardized Epic build and transfusion (Tx) guidelines, there is a belief that MTPs are inappropriately activated to rapidly gain access to multiple blood products. We sought to understand how the Epic MTP order was being utilized.

Study

Design/Methods: We performed a retrospective analysis of all RBC and SDP Txs ordered through the Epic MTP order and as individual products at our 11 acute care hospitals in 2020 and 2024. To determine if we were uniformly utilizing the MTP order, Txs were sorted by hospital type (trauma center vs non-trauma center) and order type (MTP vs individual product order). The pre-transfusion hemoglobins (pre-Tx Hb) and platelet counts (pre-Tx PltCt) tied to the Txs were compared. Results were assessed using the Student’s T-test.

Results/Findings: Table 1 shows the number of RBC and SDPs transfused and the associated mean pre-Tx Hb and pre-Tx PltCt in 2020 and 2024 at TCs and NTCs. TCs transfused 91.5% more RBCs and 86.8% more SDPs in 2020 and 84.7% more RBCs and 76.2% more SDPs is 2024 to MTP patients than NTCs. Although the Epic MTP order calls for rounds of 5 RBCs, 4 plasmas and 1 SDP, most patients for whom the MTP was activated received SDP Tx out of proportion with the number of RBCs transfused. Mean pre-Tx Hb (9.8 g/dL and 9.4 g/dL) of RBCs transfused with an MTP order at TCs was statistically higher than at NTCs (6.8 g/dL and 7.1 g/dL) (p-value < 0.001) in 2020 and 2024. Mean pre-Tx PltCt of SDPs transfused with an MTP order at TCs (160 and 172 per μL) was statistically higher than at NTCs (118 and 134 per μL) (p-value < 0.001) in 2020 and 2024. Patients with MTPs activated at NTCs in 2020 and 2024 were transfused at lower mean pre-Tx Hb (6.8 g/dL and 7.1 g/dL) and had pre-Tx Hb levels akin those of all patient transfused RBCs at NTCs (6.9 g/dL). Patients at TCs were transfused RBCs at higher mean pre-Tx Hb (7.6 g/dL and 7.5 g/dL) than those at NTCs (6.8 g/dL and 6.9 g/dL) in both 2020 and 2024 (p-value < 0.001). Patients at TCs were also transfused SDPs at higher mean pre-Tb PltCt (71 and 72 per μL) than those at NTCs (59 and 47 per μL) (p-value < 0.001).

Conclusions: Statistically significant differences in exist in the mean pre-Tx Hb and mean pre-Tx PltCt between patients transfused at TCs and NTCs within our system. In patients clinically perceived to experiencing a massive bleed, TCs activate the Epic MTP sooner than at the NTCs. Why there seems to be a delay in activation is not known but may due to 1) delayed recognition, 2) administration of emergency RBCs, 3) use of verbal blood product orders in lieu of placing an Epic MTP order, or 4) over transfusion. The impact of the transfusing at different mean pre-Tx Hb and mean pre-Tx PltCt is unknown.