Abstract
Background Massive blood loss is the most common cause of immediate death in trauma. A massive blood transfusion (MBT) score is a prediction tool to activate blood banks to prepare blood products. The previously published scoring systems were mostly developed from settings that had mature prehospital systems which may lead to a failure to validate in settings with immature prehospital systems. This research aimed to develop a massive blood transfusion for trauma (MBTT) score that is able to predict MBT in settings that have immature prehospital care. Methods This study was a retrospective cohort that collected data from trauma patients who met the trauma team activation criteria. The predicting parameters included in the analysis were retrieved from the history, physical examination, and initial laboratory results. The significant parameters from a multivariable analysis were used to develop a clinical scoring system. The discrimination was evaluated by the area under a receiver operating characteristic (AuROC) curve. The calibration was demonstrated with Hosmer–Lemeshow goodness of fit, and an internal validation was done. Results Among 867 patients, 102 (11.8%) patients received MBT. Four factors were associated with MBT: a score of 3 for age ≥60 years; 2.5 for base excess ≤–10 mEq/L; 2 for lactate >4 mmol/L; and 1 for heart rate ≥105 /min. The AuROC was 0.85 (95% CI: 0.78–0.91). At the cut point of ≥4, the positive likelihood ratio of the score was 6.72 (95% CI: 4.7–9.6, p < 0.001), the sensitivity was 63.6%, and the specificity was 90.5%. Internal validation with bootstrap replications had an AuROC of 0.83 (95% CI: 0.75–0.91). Conclusions The MBTT score has good discrimination to predict MBT with simple and rapidly obtainable parameters.
Highlights
Trauma is one of the leading causes of death globally
11 predictors were included in the multivariable model. ose predictors were age ≥60 years, Glasgow Coma Scale (GCS) score ≤8, systolic blood pressure (SBP) ≤90 mmHg, gunshot wound (GSW), heart rate (HR) ≥ 105/min, presence of pelvic fracture from physical examination, presence of femur fracture from physical examination, need for nasal packing for hemostasis, BE ≤ –10 mEq/L, lactate >4 mmol/L, and presence of free fluid from Focused Assessment Sonography in Trauma (FAST)
Multivariable logistic regression showed four parameters that remained in the model: age ≥60 years old, BE ≤ –10 mEq/L, lactate >4 mmol/L, and HR ≥ 105/min. e prediction risk of massive blood transfusion (MBT) can be written as the following equation: prediction risk of MBT –4.39 + 2.33x + 1.7x (BE ≤ –10 mEq/L) + 1.42x + 0.74x (HR ≥ 105/min). e coefficients were used to calculate the prediction score. e weightings of age, BE, lactate, and HR were 3, 2.5, 2, and 1, respectively
Summary
Trauma is one of the leading causes of death globally. In 2013, trauma accounted for 4.8 million deaths worldwide [1]. A massive blood transfusion (MBT) protocol is a preset guideline between the clinicians and the blood bank to prepare blood products in a timely manner. Many MBT scores have been published and validated [4]; the scores had good prediction only when they were applied in the same settings where the scores were created [5]. Massive blood loss is the most common cause of immediate death in trauma. A massive blood transfusion (MBT) score is a prediction tool to activate blood banks to prepare blood products. Is research aimed to develop a massive blood transfusion for trauma (MBTT) score that is able to predict MBT in settings that have immature prehospital care. E MBTT score has good discrimination to predict MBT with simple and rapidly obtainable parameters Conclusions. e MBTT score has good discrimination to predict MBT with simple and rapidly obtainable parameters
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