Schroll Rebecca, Swift David, Tatum Danielle, Couch Stuart, Heaney Jiselle B, Llado-Farrulla Monica, Zucker Shana, Gill Frances, Brown Griffin, Buffin Nicholas, Duchesne Juan
Tulane School of Medicine, New Orleans, LA, United States.
Tulane School of Medicine, New Orleans, LA, United States.
Injury. 2018 Jan;49(1):15-19. doi: 10.1016/j.injury.2017.09.015. Epub 2017 Sep 15.
Various scoring systems have been developed to predict need for massive transfusion in traumatically injured patients. Assessments of Blood Consumption (ABC) score and Shock Index (SI) have been shown to be reliable predictors for Massive Transfusion Protocol (MTP) activation. However, no study has directly compared these two scoring systems to determine which is a better predictor for MTP activation. The primary objective was to determine whether ABC or SI better predicted the need for MTP in adult trauma patients with severe hemorrhage.
This was a retrospective cohort study which included all injured patients who were trauma activations between January 1, 2009 and December 31, 2013 at an urban Level I trauma center. Patients <18 years old or with traumatic brain injury (TBI) were excluded. ABC and SI were calculated for each patient. MTP was defined as need for >10 units PRBC transfusion within 24h of emergency department arrival. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were used to evaluate scoring systems' ability to predict effective MTP utilization.
A total of 645 patients had complete data for analysis. Shock Index ≥1 had sensitivity of 67.7% (95% CI 49.5%-82.6%) and specificity of 81.3% (95% CI 78.0%-84.3%) for predicting MTP, and ABC score ≥2 had sensitivity of 47.0% (95% CI 29.8%-64.9%) and specificity of 89.8% (95% CI 87.2%-92.1%). AUROC analyses showed SI to be the strongest predictor followed by ABC score with AUROC values of 0.83 and 0.74, respectively. SI had a significantly greater sensitivity (P=0.035), but a significantly weaker specificity (P<0.001) compared to ABC score.
ABC score and Shock Index can both be used to predict need for massive transfusion in trauma patients, however SI is more sensitive and requires less technical skill than ABC score.
已经开发了各种评分系统来预测创伤患者大量输血的需求。血液消耗评估（ABC）评分和休克指数（SI）已被证明是大规模输血方案（MTP）启动的可靠预测指标。然而，尚无研究直接比较这两种评分系统以确定哪一种是MTP启动的更好预测指标。主要目的是确定ABC或SI能否更好地预测严重出血的成年创伤患者对MTP的需求。
这是一项回顾性队列研究，纳入了2009年1月1日至2013年12月31日在一家城市一级创伤中心因创伤激活而就诊的所有受伤患者。排除年龄<18岁或患有创伤性脑损伤（TBI）的患者。计算每位患者的ABC和SI。MTP定义为在急诊科就诊后24小时内需要输注超过10单位的浓缩红细胞。敏感性、特异性和受试者操作特征曲线下面积（AUROC）用于评估评分系统预测有效MTP使用的能力。
共有645例患者有完整数据可供分析。休克指数≥1预测MTP的敏感性为67.7%（95%CI 49.5%-82.6%），特异性为81.3%（95%CI 78.0%-84.3%）；ABC评分≥2预测MTP的敏感性为47.0%（95%CI 29.8%-64.9%），特异性为89.8%（95%CI 87.2%-92.1%）。AUROC分析显示，SI是最强的预测指标，其次是ABC评分，AUROC值分别为0.83和0.74。与ABC评分相比，SI的敏感性显著更高（P=0.035），但特异性显著更低（P<0.001）。
ABC评分和休克指数均可用于预测创伤患者大量输血的需求，然而，与ABC评分相比，SI更敏感且所需技术技能更少。
