Kuhne C A, Zettl R P, Fischbacher M, Lefering R, Ruchholtz S
Department of Trauma-, Reconstructive- and Hand-Surgery, University Hospital Giessen and Marburg, Baldingerstr, D-35043 Marburg, Germany.
World J Surg. 2008 Jun;32(6):1183-8. doi: 10.1007/s00268-007-9425-4.
Efficient blood transfusion management presents an ongoing challenge for many trauma centers. We present the Emergency Transfusion Score (ETS), a measure that may allow important time and cost savings in the treatment of severely injured patients in the Emergency Room (ER).
The ETS includes the parameters low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism. An ETS >or= 3 indicates a transfusion probability of 5% and was set as the cut-off to order blood products (10 packed red blood cells [PRBC]/10 fresh frozen plasma [FFP]).
A total of 481 patients requiring trauma team activation (ISS 18 +/-18; 7/03-12/04) were prospectively included. The ETS was < 3 in 306 patients (64%) and >or= 3 in 175 subjects (36%). Some 40 patients (8.3%) received blood (8 +/- 8 PRBC) after 23 +/- 9 min during ER treatment, and 39 of these patients had an ETS of >or= 3 (5.4 +/- 1.5 points). Sensitivity of the ETS was 97.5%; specificity, 68%. Positive predictive value of the ETS was 0.222; negative predictive value, 0.998.
(1) The ETS is a safe and highly sensitive tool with which to detect severely injured patients in need of blood products. (2) The ETS is highly predictive for patients not in need of PRBC (negative predictive value 0.998) and helps to avoid unnecessary cross-matching and transport. (3) After implementation of the ETS, a sum of about 109,296 USD was saved per year by reducing the costs for cross-matching, transportation, and wasted blood products.
有效的输血管理对许多创伤中心来说一直是一项挑战。我们提出了紧急输血评分（ETS），这一指标可能有助于在急诊室（ER）治疗重伤患者时节省大量时间和成本。
ETS包括低血压、超声显示有游离液体、骨盆环临床不稳定、年龄、现场入院情况和创伤机制等参数。ETS≥3表明输血概率为5%，并被设定为订购血液制品（10单位浓缩红细胞[PRBC]/10单位新鲜冰冻血浆[FFP]）的临界值。
前瞻性纳入了481例需要创伤团队救治的患者（损伤严重度评分[ISS]为18±18；时间为2003年7月至2004年12月）。306例患者（64%）的ETS＜3，175例患者（36%）的ETS≥3。约40例患者（8.3%）在急诊治疗23±9分钟后接受了输血（8±8单位PRBC），其中39例患者的ETS≥3（5.4±1.5分）。ETS的敏感性为97.5%；特异性为68%。ETS的阳性预测值为0.222；阴性预测值为0.998。
（1）ETS是一种安全且高度敏感的工具，可用于检测需要血液制品的重伤患者。（2）ETS对不需要PRBC的患者具有高度预测性（阴性预测值0.998），有助于避免不必要的交叉配血和运输。（3）实施ETS后，通过降低交叉配血、运输和浪费血液制品的成本，每年节省了约109,296美元。
