Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
Scand J Trauma Resusc Emerg Med. 2021 Jan 6;29(1):6. doi: 10.1186/s13049-020-00827-5.
Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding.
We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients.
We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89-0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently.
The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.
氨甲环酸可减少手术失血量，并降低创伤患者因出血导致的死亡。氨甲环酸必须紧急给予，最好由现场急救人员或救护车上的急救人员给予。我们开发了一种简单的评分（出血评估分诊创伤评分）来预测出血导致的死亡。
我们使用英国创伤审核研究网络（TARN）2017 年 1 月 1 日至 2018 年 12 月 31 日的数据，对 BATT 评分进行了外部验证。我们评估了创伤患者氨甲环酸治疗阈值的影响。
我们纳入了 104862 名损伤严重程度评分≥9 分的创伤患者。9915 名（9%）患者给予了氨甲环酸。其中 5185 名（52%）患者接受了院前氨甲环酸治疗。BATT 评分具有良好的准确性（Brier 评分=6%）和良好的区分度（C 统计量 0.90；95%CI 0.89-0.91）。大样本校准显示，预计和观察到的出血性死亡之间没有实质性差异（1.15%比 1.16%，P=0.81）。院前给予 BATT 评分≥2 分的创伤患者氨甲环酸治疗，可通过治疗 61598 名患者来避免 210 例出血性死亡，而不是通过治疗 9915 名患者来避免 55 例死亡。
BATT 评分可识别出有发生大出血风险的创伤患者。评分≥2 分可能是院前给予氨甲环酸治疗的适当阈值。
