Association of an integrated prehospital-to-in-hospital transfusion workflow with early outcomes in severe trauma requiring emergency transfusion: A single-center observational before-and-after study.
The Journal of international medical research · 2026-07-01 · Quasi-experimental
Abstract
ObjectiveTo evaluate the association between a prehospital-to-in-hospital integrated transfusion workflow and transfusion timeliness, coagulation-related indices, and short-term clinical outcomes in patients with severe trauma requiring emergency transfusion.MethodsThis single-center observational before-and-after study included 120 consecutive patients with severe trauma requiring emergency transfusion (60 per group). The conventional workflow group included patients treated between January 2022 and August 2023, and the integrated workflow group included patients treated between January 2024 and March 2025. The integrated workflow comprised prehospital assessment, real-time pre-arrival communication, early activation of emergency and transfusion resources, electronic transfusion ordering, and dedicated blood product delivery. The primary outcome was time to first transfusion, interpreted as a process-efficiency measure. Secondary outcomes included coagulation-related indices before transfusion and at 24 h, 24-h blood product utilization, intensive care unit length of stay, and in-hospital mortality. Univariable and multivariable analyses were performed to evaluate the association between workflow group and key outcomes.ResultsBaseline demographic, clinical, and pretransfusion laboratory characteristics were generally comparable between groups. The integrated workflow group had a shorter time to first transfusion than the conventional workflow group (25.1 ± 6.4 vs. 56.3 ± 8.2 min, p < 0.001). Fresh frozen plasma transfused within 24 h was higher in the integrated workflow group (1776 ± 348 vs. 1395 ± 317 mL, p < 0.001), whereas 24-h packed red blood cell use was similar (14.2 ± 5.4 vs. 14.7 ± 5.7 U, p = 0.645). At 24 h after transfusion, international normalized ratio and activated partial thromboplastin time were lower in the integrated workflow group (1.24 ± 0.29 vs. 1.37 ± 0.33, p = 0.022; 35.1 ± 6.6 vs. 42.1 ± 8.1 s, p < 0.001). Intensive care unit length of stay was shorter (7.3 ± 2.3 vs. 8.7 ± 3.8 days, p = 0.013). In-hospital mortality was numerically lower but did not differ significantly between groups (13.3% vs. 21.7%, p = 0.337).ConclusionsIn this single-center observational before-and-after study, a prehospital-to-in-hospital integrated transfusion workflow was associated with shorter time to first transfusion, greater early plasma administration, more favorable coagulation-related indices at 24 h, and shorter intensive care unit length of stay in patients with severe trauma requiring emergency transfusion. These findings should be interpreted primarily as evidence of improved workflow efficiency and hypothesis-generating associations with intermediate physiologic and short-term clinical outcomes. Further multicenter studies using standardized workflow timestamps, protocol-adherence assessment, and more rigorous adjustment for confounding are needed to determine whether this approach improves patient-centered outcomes across different trauma systems.
Tags
Blood products · Communication & handover · Fluids & blood · Implementation · Time intervals