Whole-blood transfusion significantly reduces mortality in adult trauma patients compared to component therapy, especially in civilian settings.

• 24-hour mortality odds ratio for whole-blood vs. component therapy: 0.76 (95% CI, 0.60-0.95).
• Civilian data shows absolute risk reduction of 4.6% with whole-blood (n=39,028), and a 30-day mortality odds ratio of 0.76 (95% CI, 0.60-0.98).

Surgeons should consider implementing whole-blood protocols selectively in civilian trauma centers.

• No significant benefit was found in military settings (n=2,171).