Relationship between Obesity and Massive Transfusion Needs in Trauma Patients, and Validation of TASH Score in Obese Population: A Retrospective Study on 910 Trauma Patients.

Audrey De Jong,Xavier Capdevila,Pauline Deras,Samir Jaber,Orianne Martinez,Jonathan Charbit,Pascal Latry

doi:10.1371/journal.pone.0152109

Audrey De Jong, Xavier Capdevila + Show 5 more

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https://doi.org/10.1371/journal.pone.0152109

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Journal: PloS one	Publication Date: Mar 24, 2016
Citations: 21	License type: CC BY 4.0

Affiliation: Hôpital Lapeyronie, Inserm

Abstract

BackgroundPrediction of massive transfusion (MT) is challenging in management of trauma patients. However, MT and its prediction were poorly studied in obese patients. The main objective was to assess the relationship between obesity and MT needs in trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT.Methods and FindingsAn observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10U of packed red blood cells in the first 24h and obesity as a BMI≥30kg/m². Between January 2008 and December 2012, 119 obese and 791 non-obese trauma patients were included. The rate of MT was 10% (94/910) in the whole population. The MT rate tended to be higher in obese patients than in non-obese patients: 15% (18/119, 95%CI 9‒23%) versus 10% (76/791, 95%CI 8‒12%), OR, 1.68 [95%CI 0.97‒2.92], p = 0.07. After adjusting for Injury Severity Score (ISS), obesity was significantly associated with MT rate (OR, 1.79[95%CI 1.00‒3.21], p = 0.049). The TASH score was higher in the obese group than in the non-obese group: 7(4–11) versus 5(2–10)(p<0.001). The area under the ROC curves of the TASH score in predicting MT was very high and comparable between the obese and non-obese groups: 0.93 (95%CI, 0.89‒0.98) and 0.94 (95%CI, 0.92‒0.96), respectively (p = 0.80). The grey zone ranged respectively from 10 to 13 and from 9 to 12 in obese and non obese patients, and allowed separating patients at low, intermediate or high risk of MT using the TASH score.ConclusionsObesity was associated with a higher rate of MT in trauma patients. The predictive performance of the TASH score and the grey zones were robust and comparable between obese and non-obese patients.

Highlights

The early detection of patients at risk of massive transfusion (MT) is nowadays the main challenge of initial management of bleeding trauma patients
Obesity was associated with a higher rate of MT in trauma patients
Some scores such as the Trauma Associated Severe Hemorrhage (TASH) score [3, 4] were developed for this specific purpose and validated for predicting MT requirements as soon as admission of trauma patients

Summary

Introduction

The early detection of patients at risk of massive transfusion (MT) is nowadays the main challenge of initial management of bleeding trauma patients. The early and aggressive triggering of haemostatic therapy was associated with an improved outcome in these patients [1, 2] Some scores such as the Trauma Associated Severe Hemorrhage (TASH) score [3, 4] were developed for this specific purpose and validated for predicting MT requirements as soon as admission of trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT

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