Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA.
Divsion of Trauma, Acute Care Surgery, and Critical Care, Tulane University School of Medicine, New Orleans, LA, USA.
World J Surg. 2020 Jun;44(6):1807-1816. doi: 10.1007/s00268-020-05394-5.
Massive transfusion (MT) is a lifesaving treatment for hemorrhaging patients. Predicting the need for MT is crucial to improve survival. The aim of our study was to validate the Revised Assessment of Bleeding and Transfusion (RABT) score to predict MT in a multicenter cohort of trauma patients.
We performed a (2015-2017) analysis of adult (age ≥ 18 year) trauma patients who had a high-level trauma team activation at three Level I trauma centers. The RABT was calculated using the 4-point score [blunt (0)/penetrating trauma (1), shock index ≥ 1 (1), pelvic fracture (1), and FAST positive (1)]. A RABT score of ≥ 2 was used to predict MT (≥ 10 units of packed red blood cells within 24 h). The area under the receiver operating characteristic curve (AUROC) was calculated to assess the score's predictive power compared to the Assessment of Blood Consumption (ABC) score.
We analyzed 1018 patients: 216 (facility I), 363 (facility II), and 439 (facility III). The mean age was 41 ± 19 year, and the injury severity score (ISS) was 29 [22-36]. The overall MT rate was 19%. The overall AUROC of RABT ≥ 2 was 0.89. The sensitivity of the RABT ≥ 2 was 78%, and the specificity was 91%. The RABT score had a higher sensitivity (78% vs. 69%) and specificity (91% vs. 82%) than the ABC score.
The RABT score is a valid tool to predict MT in severely injured trauma patients. It is an objective score that aids clinicians in predicting the need for MT to mobilize blood products and minimize the waste of resources.
大量输血（MT）是治疗出血患者的救命治疗方法。预测 MT 的需求对于提高生存率至关重要。我们的研究目的是验证修订后的出血和输血评估（RABT）评分在多中心创伤患者队列中预测 MT 的能力。
我们对三家一级创伤中心的高水平创伤团队激活的成年（年龄≥18 岁）创伤患者进行了（2015-2017 年）分析。使用 4 分评分[钝器（0）/穿透性创伤（1）、休克指数≥1（1）、骨盆骨折（1）和 FAST 阳性（1）]计算 RABT。使用 RABT 评分≥2 预测 MT（24 小时内≥10 个单位的浓缩红细胞）。计算接收者操作特征曲线（AUROC）下面积以评估与血液消耗评估（ABC）评分相比，该评分的预测能力。
我们分析了 1018 名患者：116 名来自设施 I，363 名来自设施 II，439 名来自设施 III。平均年龄为 41±19 岁，损伤严重程度评分（ISS）为 29[22-36]。总体 MT 率为 19%。RABT≥2 的总体 AUROC 为 0.89。RABT≥2 的敏感性为 78%，特异性为 91%。RABT 评分的敏感性（78%比 69%）和特异性（91%比 82%）均高于 ABC 评分。
RABT 评分是预测严重创伤患者 MT 的有效工具。它是一种客观评分，可以帮助临床医生预测 MT 的需求，以动员血液制品并最大程度地减少资源浪费。
