Abstract | BACKGROUND: There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion ( MT) protocol. OBJECTIVE: To risk stratify patients with major trauma and to predict need for MT. DESIGNS: Retrospective analysis of an administrative trauma database of major trauma patients. A REGIONAL TRAUMA CENTRE: A regional trauma centres in Hong Kong. PATIENTS: Patients with Injury Severity Score ≥ 9 and age ≥ 12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24h were excluded. MAIN OUTCOME MEASURES: Delivery of ≥ 10 units of packed red blood cells (RBC) within 24h. RESULTS: Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥ 10 units RBC within 24h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥ 120/min; systolic blood pressure ≤ 90 mm Hg; Glasgow coma scale ≤ 8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5 mmol/L; hemoglobin ≤ 7 g/dL; and hemoglobin 7.1-10 g/dL. At a cut off of ≥ 6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889. CONCLUSION: A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set.
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Authors | Timothy H Rainer, Anthony M-H Ho, Janice H H Yeung, Nai Kwong Cheung, Raymond S M Wong, Ning Tang, Siu Keung Ng, George K C Wong, Paul B S Lai, Colin A Graham |
Journal | Resuscitation
(Resuscitation)
Vol. 82
Issue 6
Pg. 724-9
(Jun 2011)
ISSN: 1873-1570 [Electronic] Ireland |
PMID | 21458905
(Publication Type: Journal Article)
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Copyright | Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. |
Topics |
- Adult
- Blood Transfusion
(methods)
- Female
- Hemorrhage
(etiology, therapy)
- Humans
- Injury Severity Score
- Male
- Middle Aged
- Retrospective Studies
- Risk Assessment
- Severity of Illness Index
- Wounds and Injuries
(complications)
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