The Massive Transfusion Score as a decision aid for resuscitation

Abstract

Introduction Prior work proposed a massive transfusion score [MTS] calculated from values obtained in the emergency department to predict likelihood of MT (massive transfusion). We hypothesized the MTS could be utilized at hour 6 to differentiate who continues to require balanced resuscitation in hour 7–24 and to predict death at 28 days. Methods We prospectively enrolled patients in whom the MT protocol (MTP) was initiated from 2005 to 2011. Data including timing of blood products were determined at hour 0, 6, 12, and 24. For each patient, transfusion needs were defined based upon either an inappropriately low hemoglobin response to transfusion or a hemoglobin decrease of > 1gm/dL if no transfusion. Timing and cause of death were utilized to account for survivor bias. Multivariate logistic regression was utilized to determine independent predictors of outcome. Results 190 MTP activations were included and by hour 6, 61% required >=10 units of PRBCs. Calculated at initial presentation, a Revised MTS (SBP<90mmHg, BD>=−6, Temp<35.5 C, INR>1.5, Hgb <11g/dL) was superior to the original MTS (including HR>=120bpm, FAST status, mechanism) or the ABC score for predicting MT (AUC MT at 6 hours 0.68, 95% CI 0.57–0.79; at 24 hour 0.72, 0.61–0.83; p<0.05); p<0.05). For those alive at hour 6, the Revised MTS was predictive of future PRBC need (AUC 0.87) in hour 7 to 12, 24-hour mortality (AUC 0.95), and 28-day mortality (AUC 0.77). For each additional positive trigger of the MTS at hour 6, the odds of death at 24 hours and 28 days was substantially increased (24 hours OR 4.6, 95% CI 2.3–9.3; 28 days OR 2.2, 95% CI 1.5–3.2, p<0.0001). Conclusion Early end points of resuscitation adopted from the components of the Revised MTS are predictive of on-going transfusion. Failure to normalize these components by hour 6 portends a particularly poor prognosis.

Viscoelastic Tissue Plasminogen Activator Challenge Predicts Massive Transfusion in 15 Minutes

“…Using an INR to identify severely injured patients with hemorrhagic shock is appealing as both pro and anticoagulants have been implicated in the pathogenesis of trauma induced coagulopathy(10). Indeed, INR has recently been shown to have superior predictability for MT than the ABC score(28), which is consistent with our findings. An INR of 1.1 of less is an excellent screening tool to rule out patients at risk of massive transfusion with a negative predictive value of 97%.…”

Massive transfusion triggers in severe trauma: Scoping review

“…Considering the AUC as reference, the three scales with the highest values are TBSS ( 36 - 37 ) (0.985 and 0.956), TASH ( 25 , 37 ) (0.912 and 0.905) and ABC ( 29 ) (0.906 at 6h and 0.903 at 24h). As for sensitivity, the TBSS ( 36 - 37 ) shows higher values (97.4%, 93.3%) when compared to other scales, such as the TASH ( 37 ) (86.7%) and the RMTS ( 35 ) (91% at 6h and 93% at 24h). Regarding the specificity, higher values were achieved in the PWH ( 5 , 32 ) (99.7% and 97.11%) and Vandromme ( 31 ) (98%), followed by the TASH ( 24 - 25 , 37 ) (97%, 83.6%) and the TBSS ( 36 - 37 ) (96.2%, 92.4%).…”

“…Massive Transfusion Score (MTS) and Revised Massive Transfusion Score (RMTS): SBP, HR, T, Hb, BE, INR, FAST and trauma type ( 34 - 35 ) .…”

“…As can be seen in Figures 3 , 4 and 5 , in some studies, NPVs are associated with individual triggers, but not with the whole scale, as with the OR, and it is highlighted the values OR>7 and NPV>80%, with Hb≤11 g/dl ( 26 , 30 , 34 ) , FAST positive ( 32 - 34 ) , SBP≤90 mmHg ( 32 - 34 ) , INR>1.5 ( 33 - 34 ) and BE≥6 ( 33 - 34 ) . Finally, the PPVs corresponding to a more accurate prediction of MT are the upper scores in the scales RMTS≥3 at 24 hours ( 35 ) (87%), PWH≥6 ( 5 ) (70.59%), McLaughlin ( 27 ) (66.4%), and when there are two positive variables in Larson ( 30 ) (54%).…”

Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members

“…Other, more recent, scoring systems for prediction of massive transfusion (MT), which partly includes prediction of persistent hemodynamic instability, such as the TASH [ 88 ], ABC [ 89 ] and the revised MTS score [ 90 ] use similar, or include more hemodynamic parameters as the parameters used in the HIS score. The TASH score weighs different hemodynamic parameters with several laboratory values, whereas the ABC score relies purely on hemodynamic parameters and the outcome of the FAST-echo.…”