One way of determining how many hospitals are using low titer group O whole blood (LTOWB) for trauma patients is to interrogate the American College of Surgeons (ACS) National Trauma Data Bank (NTDB). Reporting is mandatory for all verified trauma centers with optional participation for non-verified trauma centers, typically those seeking to obtain verification. While centers that are using LTOWB exclusively for non-trauma patients or those that do not report to NTDB will not be enumerated, the majority of centers that transfuse LTOWB for trauma patients would be expected to be captured in this registry. LTOWB has been a discreet variable captured in the registry since 2020. The most recent analysis of the NTDB database revealed that in 2022 there were 298 hospitals that transfused at least one unit of LTOWB, which was similar to the numbers in 2021 and 2022.1 Since the last analysis, data from the 2023 and 2024 NTDB datasets have been released thereby offering an opportunity for an updated assessment. Our methods for determining how many hospitals were using LTOWB for trauma patients were previously described.1, 2 Briefly, we interrogated the NTDB database to determine which patients received any volume of LTOWB. We then used the additional de-identified facility code module to assess use at the facility level. We defined pediatric patients as <15 years of age since most adult trauma centers will accept children ≥15 years of age. A “pediatric designated center” is a trauma center (Level I or II) verified by the ACS Committee on Trauma (COT), or is state-designated as such, that provides comprehensive care for injured children and can include adult centers that also treat pediatric patients. Females of child-bearing potential were defined as patients 15–50 years of age.3 NTDB captures blood products by volume, so we assumed a volume of 500 mL per unit of LTOWB. The US Army Institute of Surgical Research regulatory office reviewed protocol H-26-003nh and determined it met criteria for research not involving human subjects. In 2023 and 2024, there were 341 and 382, respectively, trauma centers listed in the NTDB that transfused at least one unit of LTOWB (Table 1). There continued to be an increase in the number of level 1 verified centers in 2023 and 2024 that transfused LTOWB, but the number of level 2, level 3, and unverified trauma centers that transfused LTOWB was relatively stable (Figure 1). Overall, there were increases in the number of facilities that transfused LTOWB to children <15 years of age, to women of childbearing potential, and to people ≥65 years of age. All of the centers that administered five or fewer LTOWB units in 2023 transfused at least one unit in 2024, suggesting consistency in LTOWB use from year to year. Conversely, there was one facility that went from three LTOWB recipients in 2023 to 368 recipients in 2024, suggesting rapid uptake in LTOWB transfusion. Consistent with previous years, the median volume of LTOWB administered was 1000 mL (IQR 500–1150 mL), which is roughly equivalent to two units. However, unlike previous years where Trauma Quality Improvement Program (TQIP) data were used, for all of the data in this report (i.e., data from 2020 through 2024), we utilized all of the NTDB entries whether the patient met TQIP criteria or not. This appeared to have no material effect on the findings, but it is worth noting that the NTDB captures more patients than the stricter TQIP criteria. There continues to be increasing use of LTOWB for resuscitating patients in traumatic hemorrhage in the United States especially at level 1 verified centers. It is interesting that the median transfused volume of LTOWB (1000 mL) has remained the same since 2021 while the median dose of LTOWB administered to children <15 years of age has remained practically the same since 2020 (13-16 mL/kg is roughly equivalent to two units administered to a 70-kg person). Perhaps some centers might still have a limit of two units per patient, or else small LTOWB inventories might limit the number of units that can be transfused per patient. It is also possible that the rapid implementation of goal-directed resuscitation leads to moderate LTOWB use per patient. Nevertheless, the LTOWB-eligible patient population continues to increase across the country. We would like to thank the American College of Surgeons for providing us with these data. SGS has received funds from the Department of Defense and SeaStar Medical in the form of grants to his institution but no salary support. MHY is on the scientific advisory board for Hemanext and Legacy Innovations, has given paid lectures for Terumo BCT, Grifols, and owns equity in Velico LLC. The US Army Institute of Surgical Research regulatory office reviewed protocol H-26-003nh and determined it met criteria for research not involving human subjects. The data that support the findings of this study are available from American College of Surgeons. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the author(s) with the permission of American College of Surgeons.
Schauer et al. (Sun,) studied this question.