Massive transfusion: outcome in blunt trauma patients.
 Over a 54-month period 6,142 patients were consecutively admitted to our Level I trauma center.
 Ninety-two blunt trauma patients required massive transfusion (MT) of 20 or more units of packed red blood cells (range, 20-126).
 Eighty-two per cent of all transfused blood was given within 24 hours of admission.
 Forty-eight patients (52%) were long-term survivors.
 Twenty-six patients died (28%) within 24 hours and 21 of these exsanguinated.
 Eighteen patients died greater than 24 hours: nine (50%) died from multiple organ failure, and nine (50%) died from severe closed head injury (CHI).
 Clinical predictors of increased mortality were: shock on admission, closed head injury, and age.
 Forty-three survivors were followed for a mean of 2.5 years (range, 1-5 years).
 No patient died during followup.
 All patients were home at 1 year; only four patients required continued medical assistance.
 Thirty-two patients (74%) returned to work.
 We conclude that: 1) blunt and penetrating trauma patients receiving MT have similar survival rates of 50%; 2) shock, closed head injury, and age predict increased mortality but do not preclude survival; 3) long-term outcome in blunt patients requiring MT is excellent.
 Post-discharge death is rare and 3/4 of the survivors return to work, justifying the high cost of acute care.
