2026-10-14T18:13:45Z https://api.figshare.com/v2/oai

oai:figshare.com:article/34048100 2026-10-01T17:30:13Z category_7 category_15 category_39 category_734 category_811 category_106 category_132 portal_5 item_type_6 month_year_10_2026

<p>Complete-case availability by model.</p> Younggoun Jo (24397562) Yunchul Park (24397559) Euisung Jeong (25157741) Hyunseok Jang (18472014) Hyo-Sin Kim (24397565) Medicine Neuroscience Ecology Biological Sciences not elsewhere classified Mathematical Sciences not elsewhere classified Science Policy Infectious Diseases population remain limited metabolic acidosis markers glasgow coma scale 79 per point sole significant predictor hosmer &# 8211 enabling risk stratification 77 &# 8211 15 min vs gcs alone achieved received massive transfusion 770 ), gcs emergency department arrival emergency department stratification tools informative predictor 60 min 124 ), &# 8805 &# 8804 gcs assessed univariate analysis transfusion appeared strongly associated predominant cohort january 2018 highest discrimination december 2023 comparable auc 828 ). 118 ). 05 ). 001 ). <div><p>Trauma patients requiring massive transfusion have mortality exceeding 40%, yet early risk-stratification tools for this population remain limited. We evaluated readily available predictors of mortality in massively transfused trauma patients, excluding those with severe traumatic brain injury (TBI) to focus on a hemorrhage-predominant cohort. This single-center retrospective cohort study included trauma patients who received massive transfusion at Chonnam National University Hospital between January 2018 and December 2023. Patients with severe TBI (Head Abbreviated Injury Scale [AIS] ≥ 4) were excluded. Three sequential multivariate logistic regression models were constructed: a primary model using variables available at emergency department (ED) arrival, a secondary model adding laboratory values, and an exploratory model incorporating early transfusion course variables. Of 172 massively transfused trauma patients, 124 met inclusion criteria (Head AIS < 4). Overall mortality was 41.1% (51/124), with 24-hour mortality of 23.7% (28/118). The Glasgow Coma Scale (GCS) was the strongest independent predictor across all models (OR = 0.77–0.79 per point, p < 0.001). In the primary ED arrival model (AUC = 0.770), GCS was the sole significant predictor; GCS alone achieved a comparable AUC of 0.771. The exploratory model incorporating transfusion variables achieved the highest discrimination (AUC = 0.828). All models showed adequate calibration (Hosmer–Lemeshow p > 0.05). Mortality decreased with longer time-to-first-transfusion (54.5% for ≤15 min vs. 23.7% for >60 min, trend p = 0.007), reflecting confounding by indication. In massively transfused trauma patients without severe TBI, GCS assessed at ED arrival is the single most informative predictor of mortality, enabling risk stratification before laboratory results become available. Metabolic acidosis markers and coagulopathy were strongly associated with mortality on univariate analysis but added no independent predictive value beyond GCS. Time-to-first-transfusion appeared to reflect hemorrhage acuity rather than a modifiable prognostic factor.</p></div> 2026-10-01T17:30:09Z Text Journal contribution 10.1371/journal.pone.0359963.s002 https://figshare.com/articles/journal_contribution/_p_Complete-case_availability_by_model_p_/34048100 CC BY 4.0