Systematic reviews of scores and predictors to trigger activation of massive transfusion protocols

Abstract

BACKGROUND The use of massive transfusion protocols (MTPs) in the resuscitation of hemorrhaging trauma patients ensures rapid delivery of blood products to improve outcomes, where the decision to trigger MTPs early is important. Scores and tools to predict the need for MTP activation have been developed for use to aid with clinical judgment. We performed a systematic review to assess (1) the scores and tools available to predict MTP in trauma patients, (2) their clinical value and diagnostic accuracies, and (3) additional predictors of MTP. METHODS MEDLINE, EMBASE, and CENTRAL were searched from inception to June 2017. All studies that utilized scores or predictors of MTP activation in adult (age, ≥18 years) trauma patients were included. Data collection for scores and tools included reported sensitivities and specificities and accuracy as defined by the area under the curve of the receiver operating characteristic. RESULTS Forty-five articles were eligible for analysis, with 11 validated and four unvalidated scores and tools assessed. Of four scores using clinical assessment, laboratory values, and ultrasound assessment the modified Traumatic Bleeding Severity Score had the best performance. Of those scores, the Trauma Associated Severe Hemorrhage score is most well validated and has higher area under the curve of the receiver operating characteristic than the Assessment of Blood Consumption and Prince of Wales scores. Without laboratory results, the Assessment of Blood Consumption score balances accuracy with ease of use. Without ultrasound use, the Vandromme and Schreiber scores have the highest accuracy and sensitivity respectively. The Shock Index uses clinical assessment only with fair performance. Other clinical variables, laboratory values, and use of point-of-care testing results were identified predictors of MTP activation. CONCLUSION The use of scores or tools to predict MTP need to be individualized to hospital resources and skill set to aid clinical judgment. Future studies for triggering nontrauma MTP activations are needed. LEVEL OF EVIDENCE Systematic review, level III.

<p>Massive Transfusion Protocols for Pediatric Patients: Current Perspectives</p>

“…For children, no such tool exists that takes into account the differences in physiology and common injury patterns that predominate in pediatric trauma. 26 However, the ideal pediatric MT prognostic tool would capture prehospital or admission hemodynamic variables, be simple, and would integrate automatically within the workflow of the resuscitation team. At present, the only validated scoring systems for children relay mortality prediction capabilities rather than signaling the need for MT.…”

Association between recipient survival and blood donor age after blood transfusion in a surgery intensive care unit: a multicenter randomized controlled trial study protocol

“…This randomized method is also feasible, as we have collected data from 60 cases using this approach. Another problem is that patients in the SICU tend to need massive transfusion, and consequently, such need will increase the difficulty in using the framed age donor’s blood [ 24 , 25 ]. If a patient requires a massive transfusion while the framed age donor’s blood is not available, we will have to exclude this case from the DAIP investigation.…”

A Selection of Trauma Scores Might Not Correlate with Coagulation Factor Activity following Multiple Injuries: A Retrospective Observational Study from a Level 1 Trauma Center

“…The TASH score is based on a logistic function of several clinical markers (sex, hemoglobin, base excess, systolic blood pressure, heart rate, injuries, or findings suspected of bleeding). From the various existing scores predicting massive transfusion after multiple injuries, we chose the TASH score because this score is well validated, and its overall accuracy seems to be superior to others [ 16 , 36 , 37 ]. Indeed, of all the scores in our study the TASH score showed the best, although only fair, correlation with the number of PRBC and FFP transfusions.…”

“…Besides anatomical injury scores like the well-known Injury Severity Score (ISS), which itself is based on the so-called Abbreviated Injury Scale (AIS), there are also a number of physiological and combined scoring systems [ 15 ]. In a recent systematic review, Shih et al assessed clinical scores and tools to predict the need for activation of a massive transfusion protocol [ 16 ]. Nevertheless, to the best of our knowledge, the capability of trauma scores to directly predict changes of clotting factor activities following severe trauma has not been investigated yet.…”