创伤后大量和紧急输血预测评分系统的比较，应用了一种新的 Bleeding Risk Index 评分，在飞行中进行。
Comparison of massive and emergency transfusion prediction scoring systems after trauma with a new Bleeding Risk Index score applied in-flight.
机构信息
From the Departments of Anesthesiology (S.Y., C.F.M., P.R., C.L., F.S., S.G., P.F.H.); Department of Surgery and Program in Trauma (T.S., S.G., D.S., P.F.H.), University of Maryland School of Medicine; Maryland Institute for Emergency Medical Services Systems (MIEMSS) (D.F., C.W.); and US Air Force C-STARS, (C.M.) Baltimore, Maryland.
出版信息
J Trauma Acute Care Surg. 2021 Feb 1;90(2):268-273. doi: 10.1097/TA.0000000000003031.
BACKGROUND
Assessment of blood consumption (ABC), shock index (SI), and Revised Trauma Score (RTS) are used to estimate the need for blood transfusion and triage. We compared Bleeding Risk Index (BRI) score calculated with trauma patient noninvasive vital signs and hypothesized that prehospital BRI has better performance compared with ABC, RTS, and SI for predicting the need for emergent and massive transfusion (MT).
METHODS
We analyzed 2-year in-flight data from adult trauma patients transported directly to a Level I trauma center via helicopter. The BRI scores 0 to 1 were derived from continuous features of photoplethymographic and electrocardiographic waveforms, oximetry values, blood pressure trends. The ABC, RTS, and SI were calculated using admission data. The area under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) was calculated for predictions of critical administration threshold (CAT, ≥3 units of blood in the first hour) or MT (≥10 units of blood in the first 24 hours). DeLong's method was used to compare AUROCs for different scoring systems. p < 0.05 was considered statistically significant.
RESULTS
Among 1,396 patients, age was 46.5 ± 20.1 years (SD), 67.1% were male. The MT rate was 3.2% and CAT was 7.6%, most (92.8%) were blunt injury. Mortality was 6.6%. Scene arrival to hospital time was 35.3 ± (10.5) minutes. The BRI prediction of MT with AUROC 0.92 (95% CI, 0.89-0.95) was significantly better than ABC, SI, or RTS (AUROCs = 0.80, 0.83, 0.78, respectively; 95% CIs 0.73-0.87, 0.76-0.90, 0.71-0.85, respectively). The BRI prediction of CAT had an AUROC of 0.91 (95% CI, 0.86-0.94), which was significantly better than ABC (AUROC, 077; 95% CI, 0.73-0.82) or RTS (AUROC, 0.79; 95% CI, 0.74-0.83) and better than SI (AUROC, 0.85; 95% CI, 0.80-0.89). The BRI score threshold for optimal prediction of CAT was 0.25 and for MT was 0.28.
CONCLUSION
The autonomous continuous noninvasive patient vital signs-based BRI score performs better than ABC, RTS, and SI predictions of MT and CAT. Bleeding Risk Index does not require additional data entry or expert interpretation.
LEVEL OF EVIDENCE
Prognostic test, level III.
背景
血液消耗评估（ABC）、休克指数（SI）和修订创伤评分（RTS）用于估计输血需求和分诊。我们比较了创伤患者非侵入性生命体征计算的出血风险指数（BRI）评分，并假设与 ABC、RTS 和 SI 相比，院前 BRI 对预测紧急和大量输血（MT）的需求具有更好的性能。
方法
我们分析了 2 年来通过直升机直接运往一级创伤中心的成年创伤患者的飞行中数据。BRI 评分 0 至 1 是从光电容积描记和心电图波形、血氧值、血压趋势的连续特征中得出的。ABC、RTS 和 SI 使用入院数据计算。使用 95%置信区间（CI）的接收器工作特征曲线下面积（AUROC）计算关键给药阈值（CAT，第 1 小时内≥3 单位血液）或 MT（第 1-24 小时内≥10 单位血液）的预测。使用 DeLong 方法比较不同评分系统的 AUROC。p<0.05 被认为具有统计学意义。
结果
在 1396 名患者中，年龄为 46.5±20.1 岁（标准差），67.1%为男性。MT 发生率为 3.2%，CAT 为 7.6%，大多数（92.8%）为钝性损伤。死亡率为 6.6%。现场到达医院的时间为 35.3±（10.5）分钟。BRI 对 MT 的预测 AUC 为 0.92（95%CI，0.89-0.95），明显优于 ABC、SI 或 RTS（AUCs=0.80、0.83、0.78，95%CI 分别为 0.73-0.87、0.76-0.90、0.71-0.85）。BRI 对 CAT 的预测 AUC 为 0.91（95%CI，0.86-0.94），明显优于 ABC（AUC，0.77；95%CI，0.73-0.82）或 RTS（AUC，0.79；95%CI，0.74-0.83），优于 SI（AUC，0.85；95%CI，0.80-0.89）。预测 CAT 的最佳 BRI 评分阈值为 0.25，预测 MT 的最佳 BRI 评分阈值为 0.28。
结论
自主连续非侵入性患者生命体征为基础的 BRI 评分在 MT 和 CAT 的预测方面优于 ABC、RTS 和 SI。出血风险指数不需要额外的数据输入或专家解释。
证据水平
预后试验，III 级。
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