From the Advanced Medical Emergency Department and Critical Care Center (T.O., Y.N., M. Nakano, M. Nakamura, K.F.), Japan Red Cross Maebashi Hospital, Maebashi; and Departments of Emergency Medicine (T.O., Y.I., M.S.), and Surgery (A.T.L.), Jichi Medical University, Tochigi, Japan.
J Trauma Acute Care Surg. 2014 May;76(5):1243-50. doi: 10.1097/TA.0000000000000200.
The ability to easily predict the need for massive transfusion may improve the process of care, allowing early mobilization of resources. There are currently no clear criteria to activate massive transfusion in severely injured trauma patients. The aims of this study were to create a scoring system to predict the need for massive transfusion and then to validate this scoring system.
We reviewed the records of 119 severely injured trauma patients and identified massive transfusion predictors using statistical methods. Each predictor was converted into a simple score based on the odds ratio in a multivariate logistic regression analysis. The Traumatic Bleeding Severity Score (TBSS) was defined as the sum of the component scores. The predictive value of the TBSS for massive transfusion was then validated, using data from 113 severely injured trauma patients. Receiver operating characteristic curve analysis was performed to compare the results of TBSS with the Trauma-Associated Severe Hemorrhage score and the Assessment of Blood Consumption score.
In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p < 0.01). The area under the receiver operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively.
The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility.
Prognostic study, level III.
能够轻松预测大量输血的需求可能会改善治疗过程，从而提前调动资源。目前，严重创伤患者激活大量输血尚无明确标准。本研究旨在创建一种评分系统来预测大量输血的需求，并验证该评分系统。
我们回顾了 119 名严重创伤患者的记录，并使用统计方法确定了大量输血的预测指标。根据多元逻辑回归分析中的比值比，将每个预测指标转换为一个简单的分数。创伤性出血严重程度评分（TBSS）定义为各组成部分评分的总和。然后使用 113 名严重创伤患者的数据验证 TBSS 对大量输血的预测价值。采用受试者工作特征曲线分析比较 TBSS 与创伤相关严重出血评分和血液消耗评估评分的结果。
在开发阶段，确定了五个大量输血的预测指标，包括年龄、收缩压、超声 Focused Assessment for Trauma 扫描、骨盆骨折严重程度和乳酸水平。TBSS 的最大值为 57 分。在验证研究中，接受大量输血的患者的平均 TBSS 明显大于（24.2[6.7]）未接受大量输血的患者（6.2[4.7]）（p<0.01）。TBSS 大于 15 分的受试者工作特征曲线下面积、敏感性和特异性分别为 0.985（显著高于其他评分系统的 0.892 和 0.813）、97.4%和 96.2%。
使用可用的 iOS 应用程序计算 TBSS 简单且准确预测大量输血的需求。需要进一步开展多中心研究以进一步验证该评分系统并进一步评估其效用。
预后研究，III 级。
