Department of Anesthesiology and Critical Care, Lapeyronie University Hospital, Montpellier, F-34295 Cedex 5, France.
Am J Emerg Med. 2013 Jan;31(1):130-6. doi: 10.1016/j.ajem.2012.06.024. Epub 2012 Sep 11.
The purpose of this study was to define whether the semiquantitative analysis of hemoperitoneum increases the accuracy of early prediction of massive transfusion (MT).
A retrospective review of severe trauma patients consecutively admitted to our trauma intensive care unit between January 2005 and December 2009 was conducted. Patients diagnosed with blunt abdominal trauma who had a computed tomography scan on admission were included. The hemoperitoneum size was defined using the Federle score on computed tomography as large, moderate, or minimal/none. The association between MT (≥10 U of packed red blood cells in the first 24 h) and moderate and large sizes of hemoperitoneum was assessed using a multiple logistic model.
Of the 381 patients meeting the inclusion criteria, 270 (71%) were male; the mean age was 35.5 ± 18.2 years and mean injury severity score was 23.4 ± 17. Ninety-seven (26%) had large hemoperitoneum, 107 (28%) had moderate hemoperitoneum, and 177 (46%) had minimal/no hemoperitoneum. Eighty-three patients (22%) required MT. The positive predictive value for MT of a large hemoperitoneum was 41%, 23% for a moderate hemoperitoneum, and 10% for minimal/no hemoperitoneum (P < .001). The corresponding values for hypotensive patients were 61%, 32%, and 25%, respectively (P < .001). In the multivariate analysis model, only the large size of hemoperitoneum was significantly associated with MT (OR 6.4, 95% CI 2.9-14, P < .001, r(2) = 0.47).
The assessment of the size of hemoperitoneum on admission substantially improves the prediction of MT in trauma patients and should be used to trigger and guide initial haemostatic resuscitation.
本研究旨在确定腹腔积血量的半定量分析是否能提高对大量输血（MT）的早期预测准确性。
对 2005 年 1 月至 2009 年 12 月连续收治于我院创伤重症监护病房的严重创伤患者进行回顾性分析。纳入接受计算机断层扫描（CT）检查并诊断为钝性腹部创伤的患者。将腹腔积血量用 Federle 评分在 CT 上定义为大量、中度或少量/无。采用多因素逻辑回归模型评估 MT（24 小时内≥10U 浓缩红细胞）与中量和大量腹腔积血量之间的关系。
符合纳入标准的 381 例患者中，270 例（71%）为男性；平均年龄为 35.5±18.2 岁，平均损伤严重程度评分为 23.4±17.9 分。97 例（26%）存在大量腹腔积血，107 例（28%）存在中度腹腔积血，177 例（46%）存在少量/无腹腔积血。83 例（22%）需要 MT。大量腹腔积血预测 MT 的阳性预测值为 41%，中度腹腔积血为 23%，少量/无腹腔积血为 10%（P<0.001）。对于低血压患者，相应的数值分别为 61%、32%和 25%（P<0.001）。多变量分析模型中，只有大量腹腔积血量与 MT 显著相关（OR 6.4，95%CI 2.9-14，P<0.001，r(2)=0.47）。
入院时腹腔积血量的评估可显著提高对创伤患者 MT 的预测准确性，应用于触发和指导初始止血复苏。
