Early packed red blood cell transfusion in major trauma patients: Evaluation and comparison of different prediction scores for massive transfusion

Abstract

Background and Objectives Our study sought to evaluate and compare different prediction scores for massive transfusion in‐hospital packed red blood cell (PRBC) transfusions. Materials and Methods Between January 2013 and December 2018, 1843 trauma patients were enrolled in the registry of a level‐1 trauma centre. All prehospital and in‐hospital variables needed to calculate the Shock Index and RED FLAG, Assessment of Blood Consumption (ABC) and Trauma Associated Severe Hemorrhage (TASH) scores were prospectively collected in the registry. The primary endpoint was the initiation of transfusion within the first hour of the patient's arrival at the hospital. Results A total of 1767 patients were included for analysis with a mean age of 43 years (±19) and a mean Injury Severity Score of 15 (±14). The in‐hospital TASH score had the highest predictive performance overall (area under the curve [AUC] = 0.925, 95% confidence interval [CI] [0.904–0.946]), while the RED FLAG score (AUC = 0.881, 95% CI [0.854–0.908]) had the greatest prehospital predictive performance compared to the ABC score (AUC = 0.798, 95% CI [0.759–0.837]) and Shock Index (AUC = 0.795, 95% CI [0.752–0.837]). Using their standard thresholds, the RED FLAG score was the most efficient in predicting early transfusion (sensitivity: 87%, specificity: 76%, positive predictive value: 25%, negative predictive value: 99%, Youden index: 0.63). Conclusion The RED FLAG score appears to outperform both the ABC score and the Shock Index in predicting early in‐hospital transfusion in trauma patients managed by pre‐hospital teams. If adopted, this score could be used to give advance warning to trauma centres or even to initiate early transfusion during pre‐hospital care.

Step by step transfusion timeline and its challenges in trauma: A retrospective study in a level one trauma center

“…This score appears to outperform the ABC score and shock index in predicting early hospital transfusion, but would be inferior to the TASH score. However, it would appear to be more sensitive than any of these three scores 39 . The advantage is to quickly transfuse all patients with severe exsanguination.…”

“…However, it would appear to be more sensitive than any of these three scores. 39 The advantage is to quickly transfuse all patients with severe exsanguination. The risk is over-prescription of MT packs, which can lead to wastage of LBP.…”

FAST exam for the anesthesiologist

“…For instance, the FAST exam has been used to predict massive transfusions after trauma. 46 Other diagnostic uses include bladder volume measurement, evaluation of ascites before paracentesis, and aiding the differential diagnosis in critically ill patients. [47][48][49] In addition, abdominal ultrasound can be used for procedural guidance.…”

“…As practitioners improved their understanding of abdominal ultrasound, they developed ways to utilize the technique to diagnose, predict, and treat an increasing array of medical conditions. For instance, the FAST exam has been used to predict massive transfusions after trauma 46. Other diagnostic uses include bladder volume measurement, evaluation of ascites before paracentesis, and aiding the differential diagnosis in critically ill patients 47–49.…”

A Study on Transfusion of Fresh-Frozen Plasma and Packed RBC in Patients With Severe Trauma

“…By and by, this system requires quick admittance to enormous volumes of defrosted universal donor FFP, which is trying to execute. [4] Since the focal pathophysiology of hemorrhagic shock due to severe trauma is the failure in delivering the oxygen, the ideal red blood cells administration is the main part of resuscitation. generally, transfusion of red blood cells including crystalloids is required when Blood loss is more noteworthy than 25% to 30%.…”