Meyer DE, et al. - esearchers evaluated the appropriateness of critical administration threshold (CAT) and resuscitation intensity (RI) vs massive transfusion (MT) for defining mortality risk in patients undergoing major transfusions. In this Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial, they randomized patients predicted to receive MT at 12 Level I trauma centers. Findings support that RI and CAT allow determination of early mortality in patients undergoing major transfusion, catching patients missed by the MT definition. They identified that the CAT+, 3 U or greater red blood cell (RBC) in the first hour, had the best sensitivity; RI4+, RI 4 U or greater, had better specificity and good positive predictive values and negative predictive values. For patients receiving an RBC-dominant resuscitation, CAT+ may seem appropriate, however RI4+ appeared more comprehensive. Quantitative, as well as qualitative risk of death could also be assessed using RI as a continuous variable.