Ohmori Takao, Kitamura Taisuke, Ishihara Junko, Onishi Hirokazu, Nojima Tsuyoshi, Yamamoto Kotaro, Tamura Ryu, Muranishi Kentaro, Matsumoto Toshiyuki, Tokioka Takamitsu
Emergency & Critical Care Center, Kochi Health Sciences Center, Kochi, Japan.
Emergency & Critical Care Center, Kochi Health Sciences Center, Kochi, Japan.
Injury. 2017 May;48(5):1006-1012. doi: 10.1016/j.injury.2016.12.028. Epub 2016 Dec 29.
Many scoring systems for the early prediction of the need for massive transfusion (MT) have been reported; in most of these, vital signs are regarded as important. However, the validity of these scoring systems in older patients remains unclear because older trauma patients often present with normal vital signs. In this study, we investigated the effectiveness of previously described scoring systems, as well as risk factors that can provide early prediction of the need for MT in older severe trauma patients.
We prospectively collected data from a cohort of severe trauma patients (ISS ≥16 and age ≥16years) admitted from January 2007 to March 2015. Trauma Associated Severe Hemorrhage (TASH), Assessment of Blood Consumption (ABC), and Prince of Wales Hospital (PWH) scores were compared between a younger and an older group. Furthermore, the predictors associated with MT in older severe trauma patients were assessed using multivariable logistic regression analyses.
The area under the curve (AUC) was significantly smaller for older group than for younger group for all three scoring systems (p<0.05). The most important risk factors to predict the need for MT were related to anatomical factors including FAST results (odds ratio (OR): 5.58, 95% confidence interval (CI): 2.10-14.99), unstable pelvic fracture (OR: 21.56, 95% CI: 6.05-90.78), and long bone open fracture of the lower limbs (OR: 12.21, 95% CI: 4.04-39.09), along with pre-injury anticoagulant agent use (OR: 5.22, 95% CI: 1.30-19.61), antiplatelet agent use (OR: 3.81, 95% CI: 1.57-9.04), lactate levels (OR: 1.20, 95% CI: 1.04-1.39) and shock index (OR: 2.67, 95% CI: 1.05-6.84). Traditional vital signs were not early risk factors.
We suggest that MT in older trauma patients should be considered on the basis of anatomical factors, pre-injury anticoagulant or antiplatelet agent use, lactate level and SI even if traditional vital signs are normal.
已有许多用于早期预测大量输血（MT）需求的评分系统被报道；在大多数此类系统中，生命体征被视为重要因素。然而，这些评分系统在老年患者中的有效性仍不明确，因为老年创伤患者的生命体征往往正常。在本研究中，我们调查了先前描述的评分系统的有效性，以及可早期预测老年严重创伤患者MT需求的危险因素。
我们前瞻性收集了2007年1月至2015年3月收治的一组严重创伤患者（损伤严重度评分[ISS]≥16且年龄≥16岁）的数据。比较了年轻组和老年组的创伤相关严重出血（TASH）、血液消耗评估（ABC）和威尔士亲王医院（PWH）评分。此外，使用多变量逻辑回归分析评估老年严重创伤患者中与MT相关的预测因素。
在所有三种评分系统中，老年组的曲线下面积（AUC）均显著小于年轻组（p<0.05）。预测MT需求的最重要危险因素与解剖学因素有关，包括超声重点评估（FAST）结果（比值比[OR]：5.58，95%置信区间[CI]：2.10 - 14.99）、不稳定骨盆骨折（OR：21.56，95%CI：6.05 - 90.78）和下肢长骨开放性骨折（OR：12.21，95%CI：4.04 - 39.09），以及伤前使用抗凝剂（OR：5.22，95%CI：1.30 - 19.61）、抗血小板剂（OR：3.81，95%CI：1.57 - 9.04）、乳酸水平（OR：1.20，95%CI：1.04 - 1.39）和休克指数（OR：2.67，95%CI：1.05 - 6.84）。传统生命体征并非早期危险因素。
我们建议，即使传统生命体征正常，对于老年创伤患者，也应根据解剖学因素、伤前抗凝或抗血小板剂使用情况、乳酸水平和休克指数来考虑MT。
