From the Division of Acute Care Surgery, Department of Surgery, Red Duke Trauma Institute, and Mcgovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas.
J Trauma Acute Care Surg. 2024 Nov 1;97(5):799-804. doi: 10.1097/TA.0000000000004436. Epub 2024 Sep 3.
Prediction models for survival in trauma rely on arrival vital signs to generate survival probabilities. Hospitals are benchmarked on expected and observed outcomes. Prehospital blood (PB) transfusion has been shown to improve mortality, which may affect survival prediction modeling. We hypothesize that the use of PB increases the predicted survival derived from probability models compared with non-blood-based resuscitation.
All adult trauma patients presenting to a level 1 trauma center requiring emergency release blood transfusion from January 2017 to December 2021 were reviewed. Patients were grouped into those receiving PB or those who did not (no PB). Prehospital Trauma and Injury Severity Score (TRISS) and shock index were compared with those at presentation to hospital. Univariate and multivariate regressions were performed to identify factors associated with changes in survival probability at presentation.
In total, 2117 patients were reviewed (PB, 1,011; no PB, 1,106). Patients receiving PB were younger (35 vs. 40 years, p < 0.001), more likely to have blunt mechanism (71% vs. 65%, p = 0.002), and more severely injured (Injury Severity Score, 27 vs. 25; p < 0.001) and had higher rates of prehospital hypotension (44% vs. 19%, p < 0.001) and shock index (1.10 vs. 0.87, p < 0.001). Upon arrival, PB patients had lower rates of ED hypotension (34% vs. 39%, p = 0.01), and significant improvements in arrival TRISS scores (+0.09 vs. -0.02, p < 0.001) and shock index (+0.10 vs. -0.07, p < 0.001) compared with prehospital. On multivariate analysis, PB was associated with a threefold increase in unexpected survivors (odds ratio, 3.28; 95% confidence interval, 2.23-4.60).
The use of PB was associated with improved probability of survival and an increase in unexpected survivors. Applying TRISS and shock index at hospital arrival does not account for en route hemostatic resuscitation, causing patients to arrive with improved vitals despite severity of injury. Caution should be used when implementing survival probability calculations using arrival vitals in centers with prehospital transfusion capability.
Therapeutic/Care Management; Level IV.
创伤患者的生存预测模型依赖于到达时的生命体征来生成生存概率。医院的基准是预期和观察到的结果。院前输血已被证明可以降低死亡率，这可能会影响生存预测模型。我们假设与非基于血液的复苏相比，使用院前输血会增加从概率模型中得出的预测生存率。
回顾了 2017 年 1 月至 2021 年 12 月期间在一家一级创伤中心就诊并需要紧急释放输血的所有成年创伤患者。患者分为接受院前输血（PB）和未接受院前输血（无 PB）两组。比较了院前创伤和损伤严重程度评分（TRISS）和休克指数与入院时的数值。进行单变量和多变量回归以确定与入院时生存率变化相关的因素。
共回顾了 2117 例患者（PB 组 1011 例，无 PB 组 1106 例）。接受 PB 的患者年龄更小（35 岁 vs. 40 岁，p < 0.001），更有可能遭受钝性损伤（71% vs. 65%，p = 0.002），损伤更严重（损伤严重程度评分 27 分 vs. 25 分；p < 0.001），院前低血压（44% vs. 19%，p < 0.001）和休克指数（1.10 vs. 0.87，p < 0.001）的发生率更高。入院时，PB 患者 ED 低血压发生率较低（34% vs. 39%，p = 0.01），到达时 TRISS 评分（+0.09 分 vs. -0.02 分，p < 0.001）和休克指数（+0.10 分 vs. -0.07 分，p < 0.001）均显著改善。多变量分析显示，与院前相比，PB 与意外幸存者的数量增加三倍相关（比值比，3.28；95%置信区间，2.23-4.60）。
使用 PB 与生存率的提高和意外幸存者数量的增加有关。在医院到达时应用 TRISS 和休克指数并不能说明途中止血复苏的情况，这导致患者尽管受伤严重但到达时生命体征有所改善。在具有院前输血能力的中心使用到达时的生命体征进行生存概率计算时应谨慎。
治疗/护理管理；IV 级。
