The Queen's Medical Center, Honolulu, Hawaii (Mss Day and Ng, Mr Severino, and Dr Hayashi); and University of Hawaii School of Medicine, Honolulu (Dr Huang).
J Trauma Nurs. 2021;28(6):341-349. doi: 10.1097/JTN.0000000000000613.
Hemorrhage is a leading cause of early mortality following trauma. A massive transfusion protocol (MTP) to guide resuscitation while bleeding is definitively controlled may improve outcomes. Prompts to initiate massive transfusion (MT) include shock index (SI) and the Assessment of Blood Consumption (ABC) score.
To compare SI with the ABC score for association with transfusion requirement, need for emergency hemorrhage interventions, and early mortality.
A retrospective cohort analysis of trauma MTP activations at our Level I trauma center was conducted from January 1, 2012, to December 31, 2016. The study data were obtained from the Trauma Registry and the blood bank. An SI cutoff of 1.0 was chosen for comparison with the positive ABC score.
The study cohort included 146 patients. Shock index ≥ 1 had significant association with MT requirement (p = .002) whereas a positive ABC score did not (p = .65). More patients with SI ≥ 1 required bleeding control interventions (67% surgery, 47% interventional radiology) than patients having a positive ABC score (49% surgery, 29% interventional radiology). For geriatric patients who received MT, 65% had SI ≥ 1 but only 30% had a positive ABC score. Three-hour mortality following emergency department arrival was similar (60% SI ≥ 1, 62% positive ABC score).
Shock index ≥ 1 outperformed a positive ABC score for association with MT requirement. Shock index is a simple tool registered nurses can independently utilize to anticipate MT.
出血是创伤后早期死亡的主要原因。在明确控制出血的同时，采用大量输血方案（MTP）指导复苏可能会改善预后。启动大量输血（MT）的提示包括休克指数（SI）和评估血液消耗（ABC）评分。
比较 SI 与 ABC 评分与输血需求、紧急出血干预的需求以及早期死亡率的关系。
对 2012 年 1 月 1 日至 2016 年 12 月 31 日期间在我们的一级创伤中心激活的创伤 MTP 进行回顾性队列分析。研究数据来自创伤登记处和血库。选择 SI 截断值为 1.0 与阳性 ABC 评分进行比较。
研究队列包括 146 名患者。SI≥1 与 MT 需求有显著关联（p=0.002），而阳性 ABC 评分则没有（p=0.65）。更多 SI≥1 的患者需要出血控制干预（67%手术，47%介入放射学），而阳性 ABC 评分的患者则为 49%手术，29%介入放射学。对于接受 MT 的老年患者，65%有 SI≥1，但只有 30%有阳性 ABC 评分。急诊科到达后 3 小时死亡率相似（60%SI≥1，62%阳性 ABC 评分）。
SI≥1 与 MT 需求的相关性优于阳性 ABC 评分。SI 是注册护士可以独立使用的简单工具，可以预测 MT。
