D'Souza Karan, Norman Mathew, Greene Adam, Finney Colby J F, Yan Matthew T S, Trudeau Jacqueline D, Wong Michelle P, Shih Andrew, Dawe Philip
Section of Acute Care Surgery and Trauma, Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Injury. 2023 Jan;54(1):19-24. doi: 10.1016/j.injury.2022.09.022. Epub 2022 Sep 18.
Early damage control resuscitation and massive transfusion (MT) protocol activations improve outcomes in trauma patients with hemorrhagic shock, where scores to guide MT prediction are used including: the Assessment of Blood Consumption (ABC), Shock Index (SI), and Revised Assessment of Bleeding and Transfusion (RABT) scores. Our aim was to validate the RABT score in patients from two level I trauma centers in Canada.
A retrospective review of adult patients meeting trauma team activation criteria receiving >1 unit of red blood cells (RBCs) within 24 h of admission, from 2015 to 2020, was conducted. A RABT score ≥ 2, ABC score ≥ 2, and Shock Index (SI) ≥ 1 was used to predict MT using both research (≥10 RBCs in 24 h) and clinical (≥3 RBCs in 3 h) definitions. Scores were assessed and compared using sensitivity, specificity, and the area under the receiver operating characteristic (AUROC).
We analyzed 514 patients with a mean age of 44.4 (19.2) years and a median injury severity score of 29 [18-38]. For both MT definitions, the RABT score trended towards higher sensitivity and lower specificity compared to ABC score and SI. For both research and clinical definitions of MT, the AUROC for the RABT score was not significantly higher (Research - RABT: 0.673 [0.610-0.735], ABC: 0.642 [0.551-0.734], SI 0.691 [0.625-0.757]; Clinical - RABT: 0.653 [0.608-0.698], ABC: 0.646 [0.600-0.691], SI 0.610 [0.559-0.660]).
The RABT score is a valid tool for predicting the need for MTPs, performing similarly with a trend towards higher sensitivity when compared to the ABC score and SI.
早期损伤控制复苏和大量输血（MT）方案的启动可改善出血性休克创伤患者的预后，目前有多种评分用于指导MT预测，包括：失血评估（ABC）、休克指数（SI）和修订版出血与输血评估（RABT）评分。我们的目的是在加拿大两个一级创伤中心的患者中验证RABT评分。
对2015年至2020年期间符合创伤团队启动标准、入院后24小时内接受超过1单位红细胞（RBC）的成年患者进行回顾性研究。使用RABT评分≥2、ABC评分≥2和休克指数（SI）≥1，依据研究定义（24小时内≥10个RBC）和临床定义（3小时内≥3个RBC）来预测MT。使用敏感性、特异性和受试者工作特征曲线下面积（AUROC）对评分进行评估和比较。
我们分析了514例患者，平均年龄44.4（19.2）岁，中位损伤严重程度评分为29[18 - 38]。对于两种MT定义，与ABC评分和SI相比，RABT评分的敏感性有升高趋势，特异性有降低趋势。对于MT的研究定义和临床定义，RABT评分的AUROC均未显著更高（研究 - RABT：0.673[0.610 - 0.735]，ABC：0.642[0.551 - 0.734]，SI 0.691[0.625 - 0.757]；临床 - RABT：0.653[0.608 - 0.698]，ABC：0.646[0.600 - 0.691]，SI 0.610[0.559 - 0.660]）。
RABT评分是预测大量输血方案需求的有效工具，与ABC评分和SI相比，表现相似且敏感性有升高趋势。
