Horst Klemens, Lentzen Rachel, Tonglet Martin, Mert Ümit, Lichte Philipp, Weber Christian D, Kobbe Philipp, Heussen Nicole, Hildebrand Frank
Department of Trauma and Reconstructive Surgery, University Hospital, RWTH 52074 Aachen, Germany.
Department of Emergency, Liege University Hospital, Domaine du Sart Tilman, 4000 Liege, Belgium.
J Clin Med. 2020 Mar 30;9(4):945. doi: 10.3390/jcm9040945.
The modified Trauma-Induced Coagulopathy Clinical Score (mTICCS) presents a new scoring system for the early detection of the need for a massive transfusion (MT). While validated in a large trauma cohort, the comparison of mTICCS to established scoring systems is missing. This study therefore validated the ability of six scoring systems to stratify patients at risk for an MT at an early stage after trauma. A dataset of severely injured patients (ISS ≥ 16) derived from the database of a level I trauma center (2010-2015) was used. Scoring systems assessed were Trauma-Associated Severe Hemorrhage (TASH) score, Prince of Wales Hospital (PWH) score, Larson score, Assessment of Blood Consumption (ABC) score, Emergency Transfusion Score (ETS), and mTICCS. Demographics, diagnostic data, mechanism of injury, injury pattern (graded by AIS), and outcome (length of stay, mortality) were analyzed. Scores were calculated, and the area under the receiver operating characteristic curves (AUCs) were evaluated. From the AUCs, the cut-off point with the best relationship of sensitivity-to-specificity was used to recalculate sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). A total of 479 patients were included; of those, blunt trauma occurred in 92.3% of patients. The mean age of patients was 49 ± 22 years with a mean ISS of 25 ± 29. The overall MT rate was 8.4% ( = 40). The TASH score had the highest overall accuracy as reflected by an AUC of 0.782 followed by the mTICCS (0.776). The ETS was the most sensitive (80%), whereas the TASH score had the highest specificity (82%) and the PWH score had the lowest (51.83%). At a cut-off > 5 points, the mTICCS score showed a sensitivity of 77.5% and a specificity of 74.03%. Compared to sophisticated systems, using a higher number of weighted variables, the newly developed mTICCS presents a useful tool to predict the need for an MT in a prehospital situation. This might accelerate the diagnosis of an MT in emergency situations. However, prospective validations are needed to improve the development process and use of scoring systems in the future.
改良创伤诱导凝血病临床评分（mTICCS）提出了一种用于早期检测大量输血（MT）需求的新评分系统。虽然该评分系统已在一个大型创伤队列中得到验证，但mTICCS与现有评分系统的比较尚缺。因此，本研究验证了六种评分系统在创伤后早期对有MT风险患者进行分层的能力。使用了来自一级创伤中心数据库（2010 - 2015年）的重伤患者（损伤严重度评分[ISS]≥16）数据集。评估的评分系统包括创伤相关严重出血（TASH）评分、威尔士亲王医院（PWH）评分、拉森评分、血液消耗评估（ABC）评分、紧急输血评分（ETS）和mTICCS。分析了人口统计学、诊断数据、损伤机制、损伤模式（按简明损伤定级标准[AIS]分级）和结局（住院时间、死亡率）。计算评分，并评估受试者工作特征曲线（ROC曲线）下面积（AUC）。根据AUC，使用敏感度与特异度关系最佳的截断点重新计算敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。共纳入479例患者；其中，92.3%的患者为钝性创伤。患者的平均年龄为49±22岁，平均ISS为25±29。总体MT率为8.4%（n = 40）。TASH评分的总体准确性最高，AUC为0.782，其次是mTICCS（0.776）。ETS最敏感（80%），而TASH评分的特异度最高（82%），PWH评分最低（51.83%）。在截断点>5分时，mTICCS评分的敏感度为77.5%，特异度为74.03%。与使用更多加权变量的复杂系统相比，新开发的mTICCS是预测院前MT需求的有用工具。这可能会加速紧急情况下MT的诊断。然而，未来需要进行前瞻性验证以改进评分系统的开发过程和应用。
