Serial Hemoglobin and Hematocrit Futility in Blunt Solid Organ Injury

IntroductionRoutine serial hemoglobin (Hgb) testing is commonly used in patients with blunt solid organ injury; however, the incremental predictive value of Hgb decline for subsequent operative (OR) or interventional radiology (IR) intervention remains uncertain.We evaluated whether a decline in Hgb was independently associated with intervention when considered alongside commonly assessed clinical and physiologic factors. MethodsWe retrospectively reviewed trauma patients with blunt liver, spleen, or kidney injuries admitted to a Level I trauma center (2021)(2022)(2023)(2024)(2025).Out of 180 patients, those requiring immediate operation (n=103) were excluded.The remaining 77 patients were initially managed nonoperatively and later required OR or IR intervention.Candidate triggers included physical examination changes, hemodynamic changes, Hgb decline ≥2 g/dL, and trauma bay transfusion.Associations were analyzed using contingency tables and multivariable logistic regression. ResultsPhysical examination changes, hemodynamic changes, and trauma bay transfusion were not associated with intervention within 24 h.An Hgb decline ≥2 g/dL was associated with lower odds of intervention (odds ratio (OR): 0.28, 95% confidence interval (CI): 0.08-1.00,p=0.049).Physiologic covariates did not improve model performance. ConclusionIn this retrospective cohort, serial Hgb decline was not an independent predictor of OR or IR intervention.The inverse association observed should not be interpreted as evidence that Hgb monitoring has no clinical role.Rather, Hgb trends should be interpreted in conjunction with hemodynamic status, physical examination, imaging, transfusion requirements, and overall clinical trajectory.