Abstract
Background: Management of hemorrhage plays a critical role in acute trauma care, owing to its significant association with morbidity and mortality in severely injured patients. We aimed at comparing the accuracy of three prediction models Trauma Associated Severe Hemorrhage (TASH) score, Assessment of Blood Consumption (ABC) score and Emergency Transfusion Score (ETS) for early estimation of the probability of massive transfusion, and its prognostic significance following trauma. Methods and Materials: retrospective analysis all cases of trauma, who required transfusion of >3 units of packed red blood cells (PRBC) was conducted for the duration of six months. Massive transfusion was defined as transfusion of >10 units of packed red blood cells within 24 hours. Correlation of all scoring systems with the probability of mass transfusion, severity of injury and in hospital mortality was done. Area under receiver operating characteristic (AUROC) Curve used to compare the scoring systems. Sensitivity, specificity, positive and negative predictive values were calculated for different prediction models. Results: 13.7% of the patients included in the study received massive transfusion. The accuracy was the highest for TASH score (57.1%) followed by ETS score (22.8%) and ABC score (13.1%). Statistically significant association was observed between TASH score and PRBC units transfused (p 0.003). 87 patients died within the duration of this study, association of lower ETS score with in hospital mortality was fund to be statistically significant Conclusion: TASH score predicts the individual’s risk for massive transfusion at a very early stage following severe injury. The scoring system may indicate risk and impact trauma care management strategies to stop bleeding and stabilize coagulation.
Highlights
Exsanguination preventable is the most common cause of mortality following severe injury
The primary aim of this study was to compare the accuracy of Trauma Associated Severe Hemorrhage (TASH) score, Assessment of Blood Consumption (ABC) score and Emergency Transfusion Score (ETS) for early estimation of the probability of massive transfusion in trauma patients
13.7% patients required multiple transfusions (MT) in our study, which is slightly higher than those reported by Poon et al [9] (2.6%) and Rainer et al [10] (
Summary
Exsanguination preventable is the most common cause of mortality following severe injury. Hemorrhage being a major contributor of morbidity and mortality of injury, attaining and maintaining hemostasis is a key consideration in trauma care [2]. Though blood transfusion results in volume restoration and improved oxygen carrying capacity in the injured patient, it carry’s adjunct various immunosuppressive and infectious consequences [5]. Management of hemorrhage plays a critical role in acute trauma care, owing to its significant association with morbidity and mortality in severely injured patients. We aimed at comparing the accuracy of three prediction models Trauma Associated Severe Hemorrhage (TASH) score, Assessment of Blood Consumption (ABC) score and Emergency Transfusion Score (ETS) for early estimation of the probability of massive transfusion, and its prognostic significance following trauma
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