Department of Accident and Emergency Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Resuscitation. 2011 Jun;82(6):724-9. doi: 10.1016/j.resuscitation.2011.02.016. Epub 2011 Apr 1.
There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion (MT) protocol.
To risk stratify patients with major trauma and to predict need for MT.
Retrospective analysis of an administrative trauma database of major trauma patients. A REGIONAL TRAUMA CENTRE: A regional trauma centres in Hong Kong.
Patients with Injury Severity Score ≥ 9 and age ≥ 12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24h were excluded.
Delivery of ≥ 10 units of packed red blood cells (RBC) within 24h.
Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥ 10 units RBC within 24h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥ 120/min; systolic blood pressure ≤ 90 mm Hg; Glasgow coma scale ≤ 8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5 mmol/L; hemoglobin ≤ 7 g/dL; and hemoglobin 7.1-10 g/dL. At a cut off of ≥ 6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889.
A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set.
目前仅有有限的证据可以指导识别需要启动大量输血（MT）方案的大量、无法控制的出血患者。
对严重创伤患者进行风险分层，并预测其是否需要 MT。
对严重创伤患者的行政创伤数据库进行回顾性分析。
香港的一个区域性创伤中心。
纳入损伤严重程度评分≥9 分且年龄≥12 岁的患者。排除烧伤患者、已知严重贫血和肾衰竭患者、或在 24h 内死亡的患者。
24h 内输注≥10 单位浓缩红细胞（RBC）。
2001 年 1 月 1 日至 2009 年 6 月 30 日期间，共有 1891 例患者符合纳入标准。92 例患者在 24h 内需要输注≥10 单位 RBC。有 7 个在急诊科容易测量且显著预测 MT 需要的变量：心率≥120/min；收缩压≤90mmHg；格拉斯哥昏迷评分≤8；骨盆移位骨折；CT 扫描或 FAST 检查有液体阳性；碱缺失>5mmol/L；血红蛋白≤7g/dL；血红蛋白 7.1-10g/dL。当截断值≥6 时，预测 MT 需要的总体正确分类率为 96.9%，灵敏度为 31.5%，特异性为 99.7%，MT 发生率为 82.9%。曲线下面积为 0.889。
已经制定了一种用于确定大量输血可能性增加的预测规则。这需要在独立数据集进行验证。
