Emergency transfusion of uncross-matched O-type red blood cells in patients with severe pelvic fracture: a multi-center propensity score-weighted analysis

BACKGROUND: The transfusion of uncross-matched O-type red blood cells (URBCs) is the global standard of care for emergency resuscitation in trauma. However, its application in China remains limited due to concerns over safety and resource availability. This study aimed to evaluate the clinical efficacy and safety of URBCs in patients with severe pelvic fractures. METHODS: In this multicenter, retrospective cohort study (2019-2023), patients with severe pelvic fractures (Abbreviated Injury Scale [AIS]≥3) transfused within 24 h of admission were stratified into the URBC and non-URBC groups. Propensity score overlap weighting (PSOW) was used to address confounding factors. The primary outcome was 30-day in-hospital mortality. Secondary outcomes included length of stay (LOS), 24-hour blood product consumption, and in-hospital complications. No clinically significant acute hemolytic transfusion reactions were observed during the study period. Furthermore, subgroup analysis of non-O-type blood recipients (57.1%) showed no significant differences in mortality compared with their O-type counterparts, and no acute hemolytic transfusion reactions were observed. CONCLUSION: Early administration of URBCs for severe pelvic fractures is safe. While not associated with increased mortality or hemolytic transfusion reactions, early use of URBCs was linked to a significant reduction in coagulation-related blood product consumption. This study provides evidence supporting the implementation of URBC within resource-constrained trauma setting to improve resuscitation efficiency.