Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Trauma Acute Care Surg. 2012 Jan;72(1):211-5. doi: 10.1097/TA.0b013e318240507b.
Hemorrhage is the leading cause of preventable death in trauma patients, of which 3% require massive transfusion (MT). MT predictive models such as the Assessment of Blood Consumption (ABC), Trauma-Associated Severe Hemorrhage (TASH), and McLaughlin scores have been developed, but only included patients requiring blood transfusion during their hospital stay, excluding a large percentage of trauma patients. Our purpose was to validate these MT predictive models in our rural Level I trauma center patient population, using all major trauma victims, regardless of blood product requirements.
Review of all Level I trauma patients admitted in 2008 to 2009 was performed. ABC, TASH, and McLaughlin scores were calculated using 80% probability for the need for MT.
Three hundred seventy-three patients were admitted; 13% had a penetrating mechanism and 52% were scene transports. MT patients had higher Injury Severity Score (median, 43 vs. 13; p < 0.001) and lower Trauma-Injury Severity Score (0.310 vs. 0.983; p < 0.001). Mortality was higher in MT patients (18.4% vs. 5.4%; p < 0.009). Thirty-eight (10%) required MT; 34 were predicted by ABC, one by TASH, and six by McLaughlin. ABC (area under the receiver operating characteristic [AUROC] = 0.86) was predictive of MT, whereas TASH (AUROC = 0.51) and McLaughlin (AUROC = 0.56) were not.
The ABC score correctly identified 89% of MT patients and was predictive of MT in major trauma patients at our rural Level I trauma center; the TASH and McLaughlin scores were not. The ABC score is simpler, faster, and more accurate. Based on this work, we strongly recommend adoption of the ABC score for MT prediction.
出血是创伤患者可预防死亡的主要原因，其中 3%需要大量输血（MT）。已经开发了诸如评估血液消耗（ABC）、创伤相关严重出血（TASH）和麦克劳林评分等 MT 预测模型，但这些模型仅包括在住院期间需要输血的患者，排除了很大一部分创伤患者。我们的目的是使用所有主要创伤患者，无论其血液制品需求如何，在我们的农村一级创伤中心患者人群中验证这些 MT 预测模型。
对 2008 年至 2009 年期间入院的所有一级创伤患者进行了回顾性研究。使用 MT 需求概率为 80%计算 ABC、TASH 和麦克劳林评分。
共收治 373 例患者，其中 13%为穿透性机制，52%为现场转运。MT 患者的损伤严重程度评分更高（中位数，43 对 13；p<0.001），创伤损伤严重程度评分更低（0.310 对 0.983；p<0.001）。MT 患者死亡率更高（18.4%对 5.4%；p<0.009）。38 例（10%）需要 MT；34 例由 ABC 预测，1 例由 TASH 预测，6 例由麦克劳林预测。ABC（受试者工作特征曲线下面积 [AUROC] = 0.86）可预测 MT，而 TASH（AUROC = 0.51）和麦克劳林（AUROC = 0.56）则不行。
ABC 评分正确识别了 89%的 MT 患者，可预测我们农村一级创伤中心的主要创伤患者的 MT；TASH 和麦克劳林评分则不行。ABC 评分更简单、快速且更准确。基于这项工作，我们强烈建议采用 ABC 评分进行 MT 预测。
