Abstract 04: The Most Accurate Massive Transfusion Prediction Score at the Scene of Injury: The Pre-Hospital Traumatic Bleeding Severity Score

Abstract

Background: Determination of the need for massive transfusion (MT) at the scene of injury is ideal for early activation of a MT protocol. We created and reported The Pre-hospital Traumatic Bleeding Severity Score (ph-TBSS) that is a simple and highly accurate scoring system to predict the need for MT at the scene of injury. However, the comparison study about the predictive value between the ph-TBSS and other MT predictors is not performed. Patients and Methods: A diagnostic comparison study using the registry data of the Gunma Prefectural Helicopter Emergency Medical Service (HEMS) was conducted. Records between Sep. 2012 and Apr. 2017 were reviewed, and adult trauma patients transported by the HEMS were included. A physician in the HEMS is always on board, primary survey including abdominal sonography scanning is performed at the scene of injury, and lactate was measured by portable equipment. The potential predictors of MT (10 units or more of packed red blood cells transfusion within 24 hours of injury) at the scene of injury were defined as following; The ph-TBSS, Assessment of Blood Consumption (ABS) score, the shock index, lactate concentration, and the presence of cold sweat. Each predictor was retrospectively calculated or reviewed from the registry data. Each predictive value was analyzed by the area under the receiver operating characteristic curve (AUROC) and the AUROC comparison analysis was performed. Results: 1025 patients were analyzed. Each AUROC for MT was following; ph-TBSS vs ABC score vs shock index vs lactate concentration vs presence of cold sweat = 0.97 [0.96-0.98] vs 0.83 [0.81-0.85] vs 0.89 [0.87-0.91] vs 0.91 [0.90-0.93] vs 0.70 [0.67-0.72]. The AUROC of the ph-TBSS was significantly higher compared to the AUROC of the other predictors (Bonferroni adjusted p<0.01). Conclusion: At the scene of injury, the ph-TBSS represented the highest predictive value for MT, compared to the ABC score, shock index, lactate concentration, or presence of cold sweat.