From the Department of Surgery (A.T.T., B.P.S., M.V.B., K.R.M., B.G.H.), University of Louisville, Louisville, Kentucky; School of Medicine (R.A.H., W.I.M.); University of Louisville, Louisville, Kentucky; and Department of Surgery (J.M.G.), University of Louisville, Louisville, Kentucky.
J Trauma Acute Care Surg. 2018 Aug;85(2):298-302. doi: 10.1097/TA.0000000000001949.
Hemorrhage is the most common cause of early death in trauma patients. Massive transfusion protocols (MTPs) have been designed to accelerate the release of blood products but can result in waste if activated inappropriately. The Assessment of Blood Consumption (ABC) score has become a widely accepted score for MTP activation. In this study, we compared the use of ABC criteria to physician judgment in MTP activation.
Adult trauma patients treated at University of Louisville Trauma Center from January 2016 to December 2016 were studied. Activation via ABC score was assessed retrospectively from emergency department (ED) data. Location, timing of activation, percent of patients using more than 5 units of packed red blood cells, amount of product waste, factors associated with early activation by physicians, and mortality were analyzed.
Three thousand four hundred twenty-one patients were included in this study. Only 33% of the patients who would have had MTP activation based on the ABC criteria used more than 5 units of blood products within 24 hours of admission compared with 65% of the patients in whom clinical judgment was used. Seventy-six percent of all MTP activations from clinical judgment would have been activated by the ABC criteria in the ED. Fifty-five percent of all MTP activations via clinical judgment were activated in the operating room and 41% in the ED. Eighty-one percent of activations that occurred in the operating room by physician judgment could have been activated earlier in the ED if the ABC criteria had been used. However, ABC score can lead to higher potential fresh frozen plasma waste (588 vs. 84 units) compared with physician judgment.
The ABC criteria overestimate need for massive transfusion and can lead to increased product waste compared with physician judgment, but its use leads to earlier MTP activation. Criteria to trigger MT activation should rely on both clinical acumen and validated prediction tools.
Prognostic, level III.
出血是创伤患者早期死亡的最常见原因。大量输血方案（MTP）旨在加速血液制品的释放，但如果使用不当，可能会造成浪费。评估血液消耗（ABC）评分已成为广泛接受的 MTP 激活评分。在这项研究中，我们比较了 ABC 标准与医生判断在 MTP 激活中的应用。
研究纳入 2016 年 1 月至 2016 年 12 月在路易斯维尔大学创伤中心治疗的成年创伤患者。从急诊科（ED）数据中回顾性评估 ABC 评分的激活情况。分析激活地点、时间、超过 5 单位浓缩红细胞的患者比例、产品浪费量、医生早期激活的相关因素以及死亡率。
本研究共纳入 3421 例患者。根据 ABC 标准，只有 33%的患者在入院后 24 小时内需要 MTP 激活，而使用临床判断的患者中这一比例为 65%。76%的临床判断 MTP 激活在 ED 时可根据 ABC 标准激活。55%的所有临床判断的 MTP 激活是在手术室进行的，41%是在 ED 进行的。如果使用 ABC 标准，81%由医生判断在手术室进行的激活可以更早地在 ED 进行。然而，与医生判断相比，ABC 评分可能导致更高的潜在新鲜冷冻血浆浪费（588 与 84 单位）。
ABC 标准高估了大量输血的需求，并可能导致与医生判断相比产品浪费增加，但它的使用可以更早地激活 MTP。触发 MT 激活的标准应同时依赖临床敏锐度和经过验证的预测工具。
预后，III 级。
