{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T10:06:23Z","timestamp":1779789983674,"version":"3.53.1"},"reference-count":34,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Definitions of massive transfusion following injury help identify patients at the greatest risk of death. However, these definitions primarily use blood component therapy. The use of whole blood (WB) transfusion protocols has seen a resurgence, with evidence of improved outcomes compared to component therapy. Therefore, our aim was to define and stratify patients into low, intermediate, and high risk for death based on volume of blood products transfused utilizing a WB-first resuscitation strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients that received at least 1 unit of whole blood following injury between January 2016 and November 2021 were identified. Receiver operating characteristic (ROC) curves to predict death based on volume of blood products transfused were constructed. Patients were stratified to low, intermediate, and high risk of death based on positive likelihood ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 785 patients identified to have received at least 1 unit of WB following injury during the study period. Based on ROC curve analysis, the best predictor of death was volume of whole blood plus packed red blood cells (PRBC) in the first hour (AUC 0.66,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Low risk of mortality was defined as WB + PRBC volume &lt;3400 cc in the first hour (14.9% mortality), intermediate risk 3400-5100 cc in the first hour (39.1% mortality), and high risk &gt;5100\u00a0mL in the first hour (66.7% mortality).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The combination of WB + PRBC volume within the first hour following injury is the best predictor of death. Further, volumes of WB + PRBC transfused within the first hour can be used to stratify patients\u2019 risk of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Type<\/jats:title>\n                    <jats:p>Prognostic and Epidemiological.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261423922","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:18:38Z","timestamp":1770751118000},"page":"1883-1890","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stratifying Early Risk of Death From Hemorrhage in the Era of Whole Blood"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1306-4989","authenticated-orcid":false,"given":"Jeff","family":"Conner","sequence":"first","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8436-9679","authenticated-orcid":false,"given":"Andrew M.","family":"Nunn","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Avery","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carma","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Carroll","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Alyce","family":"McCullough","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Mowery","sequence":"additional","affiliation":[{"name":"Ohio State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Hoth","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory R.","family":"Stettler","sequence":"additional","affiliation":[{"name":"Atrium Health Wake Forest Baptist"},{"name":"Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318221147b"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181d3599c"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000837"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000069184.82147.06"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318230089e"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001608"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamasurg.387"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.12"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000489"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000086"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000004110"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000001685"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/XCS.0000000000000708"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002498"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2023-001358"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.7178"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181e42411"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31817de3e1"},{"key":"e_1_3_3_20_2","first-page":"1","article-title":"Proceedings of the XIVth annual scientific symposium of the American red cross. 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