A prehospital scoring system for predicting the need for emergent blood product transfusion

Abstract

Background Several tools have been proven to predict the need for massive transfusion in trauma casualties, yet tools that are easily applicable in the prehospital setting for predicting the need for any blood product transfusion in the emergency department (ED) are lacking. Methods A retrospective analysis of the cross‐referenced Israeli Defense Forces Trauma Registry and the Israeli National Trauma Registry databases was performed to identify predictors for any blood product transfusion in the ED. A scoring system was developed after internally validating the prediction model. Division to risk groups was performed. Results Seven variables (systolic blood pressure, heart rate, arterial oxygen saturation, trunk involvement, mechanism of injury, chest decompression, and tourniquet application) were included in the scoring system, ranging from 0 to 11.5. Risk groups for ED transfusion included very low (0.8%), low (3.2%), intermediate (8.5%), and high (31.2%) risk. Conclusion A scoring system for predicting the need for any blood product transfusion in the ED was developed, based on information readily available in the early stages of prehospital resuscitation, allowing the receiving medical facility to prepare for that need.

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

“…37 Several clinical parameters, such as JAMA Network Open | Surgery blood pressure, heart rate, oxygen saturation, or the mechanism of injury, have been suggested as predictors for the need for massive transfusion. 38 Our finding is consistent with the results from these reports for trauma patients. 37,38 In the current study, we found the model with area under the arterial waveform in each cardiac beat, which represents the status of BP and HR, intra-operative hematocrit, SpO 2 , and ST combined with preoperative features predicted the probability of massive transfusion with the best accuracy.…”

“…38 Our finding is consistent with the results from these reports for trauma patients. 37,38 In the current study, we found the model with area under the arterial waveform in each cardiac beat, which represents the status of BP and HR, intra-operative hematocrit, SpO 2 , and ST combined with preoperative features predicted the probability of massive transfusion with the best accuracy. The importance of area under the arterial waveform in each cardiac beat is partly consistent with findings from previous studies reporting that the shock index can be used for outcome prediction in trauma patients.…”

“…In trauma patients with massive bleeding, several studies have highlighted the need for massive transfusion prediction . Several clinical parameters, such as blood pressure, heart rate, oxygen saturation, or the mechanism of injury, have been suggested as predictors for the need for massive transfusion …”

“…Our finding is consistent with the results from these reports for trauma patients . In the current study, we found the model with area under the arterial waveform in each cardiac beat, which represents the status of BP and HR, intra-operative hematocrit, Sp o 2 , and ST combined with preoperative features predicted the probability of massive transfusion with the best accuracy.…”

Use of prehospital transfusion by French emergency medical services: A national survey

“…Predictive scores for massive transfusion or severe hemorrhage were rarely used (4%), although most of the SMURs (61%) declared that they could take the LBPs as soon as the first SMUR departed. These scores, based on prehospital criteria, 16 could be of interest for PHT decisions 17,18 …”