开发和验证一种院前“红色警戒”信号，用于在钝性创伤中激活院内出血控制反应。
Development and validation of a pre-hospital "Red Flag" alert for activation of intra-hospital haemorrhage control response in blunt trauma.
机构信息
Université Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, F-94275, Le Kremlin Bicêtre, France.
CESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, Paris, CESP, INSERM, Maison de Solenn, 97 boulevard de Port-Royal, 75014, Paris, France.
出版信息
Crit Care. 2018 May 5;22(1):113. doi: 10.1186/s13054-018-2026-9.
BACKGROUND
Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures.
METHODS
A multicentre retrospective study of prospectively collected data from a trauma registry (Traumabase®) was performed. SH was defined as: packed red blood cell (RBC) transfusion in the trauma room, or transfusion ≥ 4 RBC in the first 6 h, or lactate ≥ 5 mmol/L, or immediate haemostatic surgery, or interventional radiology and/or death of haemorrhagic shock. Pre-hospital characteristics were selected using a multiple logistic regression model in a derivation cohort to develop a Red Flag binary alert whose performances were confirmed in a validation cohort.
RESULTS
Among the 3675 patients of the derivation cohort, 672 (18%) had SH. The final prediction model included five pre-hospital variables: Shock Index ≥ 1, mean arterial blood pressure ≤ 70 mmHg, point of care haemoglobin ≤ 13 g/dl, unstable pelvis and pre-hospital intubation. The Red Flag alert was triggered by the presence of any combination of at least two criteria. Its predictive performances were sensitivity 75% (72-79%), specificity 79% (77-80%) and area under the receiver operating characteristic curve 0.83 (0.81-0.84) in the derivation cohort, and were not significantly different in the independent validation cohort of 2999 patients.
CONCLUSION
The Red Flag alert developed and validated in this study has high performance to accurately predict or exclude SH.
背景
失血性休克是严重创伤患者早期可预防死亡的主要原因。延迟治疗是公认的预后因素，可以通过有效的护理组织来预防。本研究旨在开发和验证 Red Flag，这是一种二进制警报，用于识别有发生严重出血（SH）高风险的钝性创伤患者，以便由院前创伤小组使用，以触发适当的院内标准化出血控制反应：大量输血方案和/或立即止血程序。
方法
对创伤登记处（Traumabase®）前瞻性收集的数据进行多中心回顾性研究。SH 的定义为：创伤室中输注浓缩红细胞（RBC），或前 6 小时内输注≥4 RBC，或乳酸盐≥5 mmol/L，或立即进行止血手术，或介入放射学和/或失血性休克死亡。使用推导队列中的多元逻辑回归模型选择院前特征，以开发 Red Flag 二进制警报，然后在验证队列中确认其性能。
结果
在推导队列的 3675 例患者中，有 672 例（18%）发生了 SH。最终预测模型包括五个院前变量：休克指数≥1，平均动脉压≤70 mmHg，床边血红蛋白值≤13 g/dl，不稳定骨盆和院前插管。Red Flag 警报由至少两个标准的任意组合触发。其预测性能在推导队列中的敏感性为 75%（72%-79%），特异性为 79%（77%-80%），接受者操作特征曲线下面积为 0.83（0.81-0.84），在独立验证队列的 2999 例患者中无显著差异。
结论
本研究开发和验证的 Red Flag 警报具有很高的性能，可以准确预测或排除 SH。
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