Tran Alexandre, Lamb Tyler, Fernando Shannon M, Charette Manya, Nemnom Marie-Joe, Matar Maher, Lampron Jacinthe, Vaillancourt Christian
Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada.
Acute Care Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Scand J Trauma Resusc Emerg Med. 2025 Feb 20;33(1):31. doi: 10.1186/s13049-025-01336-z.
Traumatic hemorrhage is a significant cause of morbidity and mortality. There is considerable interest in risk stratification tools to aid with early activation of intervention pathways for bleeding patients. In this study, we refine the Canadian Bleeding (CAN-BLEED) score for the prediction of major interventions in bleeding trauma patients.
We conducted a mixed retrospective-prospective cohort study. We included a retrospective cohort from the CAN-BLEED derivation study, from September 2014 to September 2017. We also conducted a prospective cohort from May 2019 to August 2021 and included both datasets for refinement of the CAN-BLEED score. The primary outcome was major intervention, defined by a composite of massive transfusion, embolization, or surgery for hemostasis. Predictors were pre-specified based on previous validation work. We used a stepdown procedure and regression coefficients to create a clinical risk stratification score. We used bootstrap internal validation to assess optimism-corrected performance.
We included 1368 patients in the overall cohort. Incidence of penetrating injury was 23% and median injury severity score was 17. The overall incidence of the need for major intervention was 17%. The revised score included 8 variables: systolic blood pressure, heart rate, lactate, penetrating mechanism, pelvic instability, Focused Abdominal Sonography for Trauma positive for free fluid, computed tomography positive for free fluid, or contrast extravasation. The C-statistic for the simplified score is 0.89. A score cut-off of less than 2 points yielded a 97% (94-98%) sensitivity in ruling out the need for major intervention.
The revised CAN-BLEED score offers a clinically intuitive and internally validated tool with excellent performance in identifying patients requiring major intervention for traumatic bleeding. Further efforts are required to evaluate its performance with an external validation.
创伤性出血是发病和死亡的重要原因。人们对风险分层工具非常感兴趣，以帮助早期启动出血患者的干预途径。在本研究中，我们对加拿大出血（CAN - BLEED）评分进行了优化，以预测出血创伤患者的主要干预措施。
我们进行了一项回顾性与前瞻性相结合的队列研究。我们纳入了2014年9月至2017年9月CAN - BLEED推导研究中的回顾性队列。我们还在2019年5月至2021年8月进行了前瞻性队列研究，并纳入了两个数据集以优化CAN - BLEED评分。主要结局是主要干预措施，定义为大量输血、栓塞或手术止血的综合情况。预测因素是根据先前的验证工作预先确定的。我们使用逐步回归程序和回归系数创建了一个临床风险分层评分。我们使用自助法内部验证来评估经乐观校正后的性能。
我们在整个队列中纳入了1368例患者。穿透伤的发生率为23%，中位损伤严重程度评分为17分。需要主要干预措施的总体发生率为17%。修订后的评分包括8个变量：收缩压、心率、乳酸、穿透机制、骨盆不稳定、创伤重点腹部超声检查发现游离液体阳性、计算机断层扫描发现游离液体阳性或造影剂外渗。简化评分的C统计量为0.89。评分低于2分在排除主要干预需求方面的敏感性为97%（94 - 98%）。
修订后的CAN - BLEED评分提供了一种临床直观且经过内部验证的工具，在识别需要对创伤性出血进行主要干预的患者方面具有出色的性能。需要进一步努力通过外部验证来评估其性能。
