From the Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, the Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, the Department of Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, and the Center for Translational Injury Research and the Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston.
South Med J. 2021 Apr;114(4):193-198. doi: 10.14423/SMJ.0000000000001236.
Scoring systems, such as the Assessment of Blood Consumption (ABC) Score, are used to identify patients at risk for massive transfusion (MT, ≥10 U red blood cells in 24 hours). Our aeromedical transport helicopter uses ultrasound to perform the Focused Assessment with Sonography for Trauma (FAST) examination. Our objective was to evaluate the ability of the Prehospital ABC (PhABC) Score to predict blood transfusions and the need for emergent laparotomy.
Post hoc analysis of a prospective observational study of trauma patients who underwent an in-flight FAST during aeromedical transport during a 7-month period. PhABC Score was positive if ≥2 of the following were present in flight: penetrating trauma, heart rate >120 bpm, systolic blood pressure <90 mm Hg, or a positive abdominal FAST. The PhABC Score was evaluated by area under the receiver operating characteristic (AUROC) curves and logistic regression.
A total of 291 trauma patients met inclusion criteria, 23 underwent emergent laparotomy, and 12 received an MT. A positive PhABC Score predicted emergent laparotomy, with a positive predictive value of 48% and a negative predictive value of 95% (sensitivity 46%, specificity 96%, AUROC curve 0.83). A positive PhABC Score also predicted receipt of an MT with a positive predictive value of 28% and a negative predictive value of 94% (sensitivity 33%, specificity 93%, AUROC curve 0.77). Multiple logistic regression identified FAST as the most powerful contributor of the PhABC Score to the prediction of both emergent laparotomy (odds ratio 8.5, < 0.001) and MT (odds ratio 5.9, < 0.001).
The PhABC Score effectively predicts in-hospital resource utilization. It provides an outstanding undertriage rate from the prehospital setting, and it is helpful to improve trauma team activation, mobilize blood products, and prepare the operating room.
评分系统，如评估血液消耗（ABC）评分，用于识别有发生大量输血（MT，24 小时内输注≥10 单位红细胞）风险的患者。我们的航空医疗运输直升机使用超声进行创伤重点评估超声检查（FAST）。我们的目的是评估院前 ABC（PhABC）评分预测输血和需要紧急剖腹手术的能力。
对航空医疗运输期间 7 个月内进行飞行中 FAST 的创伤患者的前瞻性观察研究进行事后分析。如果在飞行中出现以下 2 项或以上，PhABC 评分即为阳性：穿透性创伤、心率＞120 次/分、收缩压＜90mmHg 或腹部 FAST 阳性。通过受试者工作特征（ROC）曲线下面积和逻辑回归评估 PhABC 评分。
共有 291 名创伤患者符合纳入标准，23 名患者行紧急剖腹手术，12 名患者接受 MT。PhABC 评分阳性预测紧急剖腹手术，阳性预测值为 48%，阴性预测值为 95%（敏感性 46%，特异性 96%，ROC 曲线 0.83）。PhABC 评分阳性也预测接受 MT，阳性预测值为 28%，阴性预测值为 94%（敏感性 33%，特异性 93%，ROC 曲线 0.77）。多变量逻辑回归确定 FAST 是 PhABC 评分预测紧急剖腹手术（比值比 8.5，＜0.001）和 MT（比值比 5.9，＜0.001）的最强贡献者。
PhABC 评分有效地预测院内资源利用情况。它提供了从院前环境中进行出色的分类不足率，并有助于改善创伤小组激活、动员血液制品和准备手术室。
