Abstract: Objective To assess the relationship between the initial inferior vena cava diameter and massive transfusion requirements in patients with blunt trauma. Methods We retrospectively analyzed all patients hospitalized for blunt trauma (ISS severity≥16) from 2014 to 2017. Univariate and multivariate analyses were performed to determine independent predictors of massive transfusions (defined as ≥10 units of red cell concentrate transfusions within 24 h of admission). The subject's working curve and area under the curve (AUC) were calculated. Results Two hundred and twenty-two patients were collected, including 50 patients in the massive transfusion group and 172 patients in the non-bulk transfusion group. The incidence of massive transfusion was 22.5%. Multiple regression analysis, diameter of the inferior vena cava [odds ratio (OR): 0.88; 95% confidence interval (CI), 0.80-0.96; P<0.01], fibrin degradation product (FDP; OR: 1.01; 95% CI: 1.00 -1.01;P<0.01) and fibrinogen levels (OR: 0.99; 95% CI: 0.98-1.00; P<0.01) are strong predictors of massive transfusions. Inferior vena cava diameter showed moderate accuracy (AUC: 0.74; cut-off value: 13 mm; sensitivity: 67%; specificity: 73%). The FDP value of 80.5 μg/ml, the fibrinogen concentration of 165 mg/dL, and the combined cut-off point of the inferior vena cava diameter greater than 13 mm can determine the accuracy of unnecessary large blood transfusions to be 100%. Conclusion The initial inferior vena cava diameter is a predictor of massive blood transfusion in patients with blunt trauma.

Key words: Inferior vena cava diameter, Massive transfusion, Trauma Pan, CT scan