1887
Volume 2014, Issue 1
  • ISSN: 1999-7086
  • E-ISSN: 1999-7094

Abstract

Military and civilian data would suggest that hemostatic resuscitation results in improved outcomes for exsanguinating patients. However, identification of those patients who are at risk of significant hemorrhage is not clearly defined. We attempted to identify factors that would predict the need for massive transfusion (MT) in an Australasian trauma population, by comparing those trauma patients who did receive massive transfusion with those who did not. Between 1985 and 2010, 1,686 trauma patients receiving at least 1 U of packed red blood cells were identified from our prospectively maintained trauma registry. Demographic, physiologic, laboratory, injury, and outcome variables were reviewed. Univariate analysis determined significant factors between those who received MT and those who did not. A predictive multivariate logistic regression model with backward conditional stepwise elimination was used for MT risk. Statistical analysis was performed using SPSS PASW. MT patients had a higher pulse rate, lower Glasgow Coma Scale (GCS) score, lower systolic blood pressure, lower hemoglobin level, higher Injury Severity Score (ISS), higher international normalized ratio (INR), and longer stay. Initial logistic regression identified base deficit (BD), INR, and hemoperitoneum at laparotomy as independent predictive variables. After assigning cutoff points of BD being greater than 5 and an INR of 1.5 or greater, a further model was created. A BD greater than 5 and either INR of 1.5 or greater or hemoperitoneum was associated with 51 times increase in MT risk (odds ratio, 51.6; 95% confidence interval, 24.9Y95.8). The area under the receiver operating characteristic curve for the model was 0.859. From this study, a combination of BD, INR, and hemoperitoneum has demonstrated good predictability for MT. This tool may assist in the determination of those patients who might benefit from hemostatic resuscitation.

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2014-11-01
2019-08-25
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References

  1. [1]. Nunez   TC., , Voskresensky   IV., , Dossett   LA., , Shinall   R., , Dutton   WD., , Cotton   BA. . Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)?.   J Trauma . 2009; ;66: : 346– 352 .
    [Google Scholar]
  2. [2]. Brickman   T., , Niemeyer   U., , Mutschler   M., , Wafaisade   A., , Peiniger   S., , Lefering   R., , Bouillon   B., , Maumelle   M. . Trauma Register DGU. Predicting on-going hemorrhage and transfusion requirement after severe trauma: a validation of six scoring systems and algorithms on the Trauma Register DGU. . Critical Care . 2012; ;16: : R129 . doi:10.1186/cc11432 .
    [Google Scholar]
  3. [3]. Spahn   DR., , Bouillon   B., , Cerny   V., , Coats   TJ., , Duranteau   J., , Fernández-Mondéjar   E., , Filipescu   D., , Hunt   BJ., , Komadina   R., , Nardi   G., , Neugebauer   E., , Ozier   Y., , Riddez   L., , Schultz   A., , Vincent   JL., , Rossaint   R. . Management of bleeding and coagulopathy following major trauma: an updated European guideline. . Crit Care . 2013; ;17: : R76 . doi: 10.1186/cc12685 .
    [Google Scholar]
  4. [4]. Hsu   JM., , Hitos   K., , Fletcher   JP. . Identifying the bleeding trauma patient: predictive factors for massive transfusion in an Australasian trauma population. . J Trauma Acute Care Surg . 2013; ;75: : 359– 364 .
    [Google Scholar]
  5. [5]. McCully   SP., , Fabricant   LJ., , Kunio   NR., , Groat   TL., , Watson   KM., , Differding   JA., , Deloughery   TG., , Schreiber   MA. . The International Normalized Ratio overestimates coagulopathy in stable trauma and surgical patients. . J Trauma Acute Care Surg . 2013; ;75: : 947– 953 .
    [Google Scholar]
  6. [6]. Bouglé   A., , Harrois   A., , Duranteau   J. . Resuscitative strategies in traumatic hemorrhagic shock. . Ann Intensive Care . 2013 12; ;3: : 1 . doi:10.1186/2110-5820-3-1 .
    [Google Scholar]
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  • Article Type: Letter
Keyword(s): hemorrhage , massive transfusion , prediction and trauma
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