Prehospital Validation of the Assessment of Blood Consumption (ABC) Score

Hanlin, Erin R.; Meyer, David; Heft, Nicolas; Stilgenbauer, Hutch; Cotton, Bryan A.; Bourgeois, Michele; Cabrera, Rodolfo; Osborn, Lesley

doi:10.1080/10903127.2023.2166174

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Patients were included in the observational cohort study if they were at risk of massive transfusion and met two or more of the following Assessment of Blood Consumption (ABC) criteria: 1) hypotension (SBP ≤ 90 mm Hg), 2) penetrating mechanism of injury, 3) positive Focused Assessment with Sonography in Trauma (FAST) examination, and 4) heart rate ≥ 120 bpm. [17][18][19] They also had to have undergone blood/blood component transfusion and hemorrhage control procedures within 60 minutes of arrival, in the operating room or interventional radiology suite. [17][18][19] Serial plasma samples were obtained from enrolled patients at admission (0 hours), 4 hours, and 24 hours when feasible.…”

Section: Methodsmentioning

confidence: 99%

“…[17][18][19] They also had to have undergone blood/blood component transfusion and hemorrhage control procedures within 60 minutes of arrival, in the operating room or interventional radiology suite. [17][18][19] Serial plasma samples were obtained from enrolled patients at admission (0 hours), 4 hours, and 24 hours when feasible. The cohort of patients used for the current biomarker evaluation included a convenience sample of patients having successful sample collection at all three time points and the documented presence of TBI or no TBI via CT imaging.…”

Section: Methodsmentioning

confidence: 99%

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Early GFAP and UCH-L1 point-of-care biomarker measurements for the prediction of traumatic brain injury and progression in patients with polytrauma and hemorrhagic shock

Sperry,

Luther,

Okonkwo

et al. 2024

Journal of Neurosurgery

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OBJECTIVE Traumatic brain injury (TBI) and hemorrhage are responsible for the largest proportion of all trauma-related deaths. In polytrauma patients at risk of hemorrhage and TBI, the diagnosis, prognosis, and management of TBI remain poorly characterized. The authors sought to characterize the predictive capabilities of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) measurements in patients with hemorrhagic shock with and without concomitant TBI. METHODS The authors performed a secondary analysis on serial blood samples derived from a prospective observational cohort study that focused on comparing early whole-blood and component resuscitation. A convenience sample of patients was used in which samples were collected at three time points and the presence of TBI or no TBI via CT imaging was documented. GFAP and UCH-L1 measurements were performed on plasma samples using the i-STAT Alinity point-of-care platform. Using classification tree recursive partitioning, the authors determined the measurement cut points for each biomarker to maximize the abilities for predicting the diagnosis of TBI, Rotterdam CT imaging scores, and 6-month Glasgow Outcome Scale–Extended (GOSE) scores. RESULTS Biomarker comparisons demonstrated that GFAP and UCH-L1 measurements were associated with the presence of TBI at all time points. Classification tree analyses demonstrated that a GFAP level > 286 pg/ml for the sample taken upon the patient’s arrival had an area under the receiver operating characteristic curve of 0.77 for predicting the presence of TBI. The classification tree results demonstrated that a cut point of 3094 pg/ml for the arrival GFAP measurement was the most predictive for an elevated Rotterdam score on the initial and second CT scans and for TBI progression between scans. No significant associations between any of the most predictive cut points for UCH-L1 and Rotterdam CT scores or TBI progression were found. The predictive capabilities of UCH-L1 were limited by the range allowed by the point-of-care platform. Arrival GFAP cut points remained strong independent predictors after controlling for all potential polytrauma confounders, including injury characteristics, shock severity, and resuscitation. CONCLUSIONS Early measurements of GFAP and UCH-L1 on a point-of-care device are significantly associated with CT-diagnosed TBI in patients with polytrauma and shock. Early elevated GFAP measurements are associated with worse head CT scan Rotterdam scores, TBI progression, and worse GOSE scores, and these associations are independent of other injury attributes, shock severity, and early resuscitation characteristics.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Early GFAP and UCH-L1 point-of-care biomarker measurements for the prediction of traumatic brain injury and progression in patients with polytrauma and hemorrhagic shock

Sperry,

Luther,

Okonkwo

et al. 2024

Journal of Neurosurgery

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“…The questionnaire assessed the following four aspects: the initiation of the procedure and the use of a bleeding prediction score (TASH, 11 ABC, 12 RED FLAG, 13 MGAP 14 ), the type of LBPs used according to the use of a transfusion pack, the modalities of storage and reintegration, and the obstacles to PHT and training of caregivers on the subject.…”

Section: Methodsmentioning

confidence: 99%

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

Bichot

Pasquier²,

Martinaud

et al. 2023

Transfusion

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Background Major bleeding is the leading cause of preventable mortality among trauma patients. Several studies have recently shown that prehospital plasma transfusion improves the outcomes of severely injured patients. Although no consensus has been reached, prehospital transfusion is regularly considered to reduce avoidable mortality. The objective was to assess the status of prehospital transfusion practices in France. Study Design and Methods A national survey among the 378 advance life support emergency teams (SMURs) in metropolitan France was conducted from December 15, 2020 to October 31, 2021. A questionnaire was distributed by e‐mail to the physicians in charge of SMURs. The questions addressed the transfusion modalities, labile blood products (LBPs) used, and limitations encountered in implementing transfusion. Results The response rate was 48%, and 82% of the respondents performed prehospital transfusions. A designated pack was used by 44% of the respondents. The LBPs used were packed red blood cells (100%), of which 95% were group 0 RH:‐1, fresh frozen plasma (27%), lyophilized plasma (7%), and platelets (1%). The LBPs were transported in isothermal boxes (97%) without temperature monitoring in 52% of the cases. Nontransfused LBPs were discarded in 43% of the cases. Reported limitations in implementing transfusion were the delivery time (45%), loss of LBPs (32%), and lack of evidence (46%). Discussion Prehospital transfusion was developed in France but access to plasma remains difficult. Protocols allowing the reutilization of LBPs and improving conservation could limit the waste of a rare resource. Implementing the use of lyophilized plasma could facilitate prehospital transfusion. Future studies will need to specify the role of each LBP in the prehospital setting.

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“…In 2009, Nunez et al [41] identified the accuracy of another score, the ABC Score (Assessment of Blood Consumption Score) that used simple and non-laboratory parameters (penetrating mechanism, systolic bloop pressure < 90 in the emergency department, heart rate > 120, positive FAST) to prompt understanding of the need of patients in requiring massive transfusions after trauma [41]. In the ABC Score [42] studies, a patient with a score point < 2 was unlikely to require a massive transfusion (sensitivity estimated at 75-90% and specificity estimated at 65-85%, respectively).…”

Section: Definition Of Massive Blood Transfusion and Current Protocolsmentioning

confidence: 99%

Blood Transfusion for Major Trauma in Emergency Department

Saviano,

Perotti,

Zanza

et al. 2024

Diagnostics

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Severe bleeding is the leading cause of death in patients with major trauma admitted to the emergency department. It is estimated that about 50% of deaths happen within a few minutes of the traumatic event due to massive hemorrhage; 30% of deaths are related to neurological dysfunction and typically happen within two days of trauma; and approximately 20% of patients died of multiorgan failure and sepsis within days to weeks of the traumatic event. Over the past ten years, there has been an increased understanding of the underlying mechanisms and pathophysiology associated with traumatic bleeding leading to improved management measures. Traumatic events cause significant tissue damage, with the potential for severe blood loss and the release of cytokines and hormones. They are responsible for systemic inflammation, activation of fibrinolysis pathways, and consumption of coagulation factors. As the final results of this (more complex in real life) cascade, patients can develop tissue hypoxia, acidosis, hypothermia, and severe coagulopathy, resulting in a rapid deterioration of general conditions with a high risk of mortality. Prompt and appropriate management of massive bleeding and coagulopathy in patients with trauma remains a significant challenge for emergency physicians in their daily clinical practice. Our review aims to explore literature studies providing evidence on the treatment of hemorrhage with blood support in patients with trauma admitted to the Emergency Department with a high risk of death. Advances in blood transfusion protocols, along with improvements in other resuscitation strategies, have become one of the most important issues to face and a key topic of recent clinical research in this field.

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Prehospital Validation of the Assessment of Blood Consumption (ABC) Score

Cited by 4 publications

References 20 publications

Early GFAP and UCH-L1 point-of-care biomarker measurements for the prediction of traumatic brain injury and progression in patients with polytrauma and hemorrhagic shock

Early GFAP and UCH-L1 point-of-care biomarker measurements for the prediction of traumatic brain injury and progression in patients with polytrauma and hemorrhagic shock

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

Blood Transfusion for Major Trauma in Emergency Department

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