The Algorithm Examining the Risk of Massive Transfusion (ALERT) Score Accurately Predicts Massive Transfusion at the Scene of Injury and on Arrival to the Trauma Bay: A Retrospective Analysis

Abstract

Background: Massive transfusion (MT) is required to resuscitate traumatically injured patients with complex derangements. Scoring systems for MT typically require laboratory values and radiological imaging that may delay the prediction of MT. Study Design: The Trauma ALgorithm Examining the Risk of massive Transfusion (Trauma ALERT) study was an observational cohort study. Prehospital and admission ALERT scores were constructed with logistic regression of prehospital and admission vitals, and FAST examination results. Internal validation was performed with bootstrap analysis and cross-validation. Results: The development cohort included 2,592 patients. Seven variables were included in the prehospital ALERT score: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), SpO 2 , motor Glasgow Coma Scale (GCS) score, and penetrating mechanism. Eight variables from 2,307 patients were included in the admission ALERT score: admission SBP, HR, RR, GCS score, temperature, FAST examination result, and prehospital SBP and DBP. The area under the receiving operator characteristic curve for the prehospital and admission models were 0.754 (95% bootstrapped CI 0.735-0.794, P < 0.001) and 0.905 (95% bootstrapped CI 0.867-0.923, P < 0.001), respectively. The prehospital ALERT score had equivalent diagnostic accuracy to the ABC score (P ¼ 0.97), and the admission ALERT score outperformed both the ABC and the prehospital ALERT scores (P < 0.0001). Conclusion: The prehospital and admission ALERT scores can accurately predict massive transfusion in trauma patients without the use of time-consuming laboratory studies, although prospective studies need to be performed to validate these findings. Early identification of patients who will require MT may allow for timely mobilization of scarce resources and could benefit patients by making blood products available for treating hemorrhagic shock.

Impact of early enteral nutrition on ventilator associated pneumonia in intubated severe trauma patients: A propensity score-matched study

“…Another independent risk factor of delaying EN was massive blood transfusion. Hemorrhage is the most common cause of early death in trauma patients, and massive blood transfusion is required to resuscitate traumatically injured patients with complex physiologic derangements ( 43 ). Physiologically, shock shunts blood flow away from the GI tract, however, gut perfusion remains depressed in spite of effective shock resuscitation ( 44 ).…”

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

“…However, to discern these patients is a challenge: no clinical factor in isolation can reliably define or predict exsanguinating haemorrhage. However, clinicians should have a high degree of suspicion when the mechanism of injury (MOI) is compatible with major vascular disruption, especially when shock is present immediately after the injury, and a constellation of clinical signs such as paleness, diaphoresis, air-hunger, venous collapse, hypotension (low volume or absent peripheral pulses), a low/falling ETCO 2 , tachy- or bradycardia and altered level of consciousness are present [ 57 ]. There are a number of validated algorithms that can be used to identify the need for large volume resuscitation [ 57 – 59 ].…”

“…However, clinicians should have a high degree of suspicion when the mechanism of injury (MOI) is compatible with major vascular disruption, especially when shock is present immediately after the injury, and a constellation of clinical signs such as paleness, diaphoresis, air-hunger, venous collapse, hypotension (low volume or absent peripheral pulses), a low/falling ETCO 2 , tachy- or bradycardia and altered level of consciousness are present [ 57 ]. There are a number of validated algorithms that can be used to identify the need for large volume resuscitation [ 57 – 59 ]. However, few are incorporated into useful decision support systems that can be implemented in practice, and clinicians are often reluctant to trust such tools to support treatment decisions [ 60 ].…”

What's New in Shock, October 2021?

“…Trauma and resuscitation are also topics of the manuscript by Chow and co-workers (17). In this case, the authors were interested in predicting the need for massive transfusion and aimed at developing a pre-hospital and admission Algorithm to Examine the Risk of massive Transfusion (ALERT) scores that could accurately predict massive transfusion using available pre-hospital and admission data.…”