The use of ABC score in activation of massive transfusion: The yin and the yang

Motameni, Amirreza; Hodge, R; McKinley, William I; Georgel, Jiliene M; Strollo, Brian P.; Benns, Matthew V.; Miller, Keith R.; Harbrecht, Brian G.

doi:10.1097/ta.0000000000001949

Cited by 23 publications

(34 citation statements)

References 11 publications

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“…Also, the use of other scoring systems that need laboratory tests and cumbersome calculations is inapplicable in emergency situations (Vandromme et al 2011; El-Menyar et al 2019). Recently, Motameni et al concluded that in comparison to the clinical evaluation, the ABC criteria may overestimate the need for MT and it may even increase the product wastage, however, it could lead to earlier MTP activation (Motameni et al 2018). In our study, ABC scores showed a significant correlation with SI ( r = 0.62), a finding that supports the importance of SI as a simple alternative predictor in patient with SOI.…”

Section: Discussionmentioning

confidence: 99%

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

et al. 2019

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PurposeWe aimed to assess the utility of shock index (SI) to predict the need for massive transfusion protocol (MTP) in patients with solid organ injury (SOI) in a Level 1 Trauma center.MethodsWe conducted a retrospective analysis for patients with SOI between 2011 and 2014. Patients were categorized according to on-admission SI into low (< 0.8) and high SI (≥0.8) group.ResultsA total of 4500 patients were admitted with trauma, of them 572 sustained SOIs (289 patients had SI ≥0.8). In comparison to low SI, patients with high SI were younger, had higher injury severity scores (ISS) and lower Trauma and Injury Severity Score (TRISS); (p < 0.001). The proportion of exploratory laparotomy (EXLap), blood transfusion (BT), MTP activation, sepsis and hospital mortality were significantly higher in patients with high SI. Serum lactate (r = 0.34), hematocrit (r = − 0.34), ABC score (r = 0.62), ISS (r = 0.35), and amount of transfused blood (r = 0.22) were significantly correlated with SI. On multivariable regression analysis using 9 relevant variables (age, sex, ISS, ED GCS, serum lactate, hematocrit, Abdomen AIS and Focused assessment with sonography in trauma (FAST) and SI), SI ≥ 0.8 was an independent predictor of BT (OR 2.80; 95%CI 1.56–4.95) and MTP (OR 2.81;95% CI 1.09–7.21) .ConclusionsIn patients with SOI, SI is a simple bedside predictor for BT and MTP activation. Further prospective studies are needed to support our findings.

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Section: Discussionmentioning

confidence: 99%

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

et al. 2019

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“…The Assessment of Blood Consumption (ABC) score did not use laboratory data with non-weighted variables, including HR, SBP, penetrating mechanism, and a positive FAST result. With sensitivity of 75% and specificity of 86%, the reported AUC of ABC is 0.852 [21, 22]. The Revised Assessment of Bleeding and Transfusion score was developed and the replacement of hypotension and tachycardia with a SI>1.0 and inclusion of pelvic fracture as a variable enhanced discrimination of ABC score for predicting the need for MT [23].…”

Section: Discussionmentioning

confidence: 99%

Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

Rau

Kuo

et al. 2019

PLoS ONE

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Background The shock index (SI) is defined as the ratio of heart rate/systolic blood pressure. This study aimed to determine the performance of delta shock index (ΔSI), a difference between SI upon arrival at the emergency room (ER) and that in the field, in predicting the need for massive transfusion (MT) among adult trauma patients with stable blood pressure. Methods This study included registered data from all trauma patients aged 20 years and above who were hospitalized from January 1, 2009 to December 31, 2016. Only patients who were transferred by emergency medical service from the accident site with a systolic blood pressure ≥ 90 mm Hg at the ER were included. The 7,957 enrolled trauma patients were divided into 2 groups, those who had received blood transfusion ≥ 10 U (MT, n = 82) and those who had not (non-MT, n = 7,875). The odds ratios with 95% confidence intervals for the need for MT by a given ΔSI were measured. The plot of specific receiver operating characteristic (ROC) curves was used to evaluate the best cutoff point of ΔSI that could predict the patient’s probability of receiving MT. Results ROC curve analysis showed that a ΔSI of 0.06 as the cutoff point had the highest AUC of 0.61, with a sensitivity of 0.415 and specificity of 0.841. Patients with a ΔSI ≥ 0.00 had a significant 1.8-fold increase in need for MT than those patients with a ΔSI less than 0.00 (1.4% vs. 0.8%, p = 0.01). The larger the ΔSI, the higher the odds of need for an MT. Using the cutoff point of ΔSI of 0.06, patients with a ΔSI ≥ 0.06 had a significant 3.7-fold increase in need for MT than those patients with a ΔSI less than 0.06 (2.7% vs. 0.7%, p < 0.001). Conclusions This study indicated that, in trauma patients with stable blood pressure at the ER, the accuracy of prediction of the requirement for MT by ΔSI is low. However, the size of the delta is significantly associated with need for MT and a lack of improvement in the patient’s SI at the ER compared to that in the field significantly increases the odds of a need for MT.

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“…37 Identification of bleeding patients who require massive transfusion has long relied on the judgment of surgeons or clinicians, with minimal use of validated tools. 39 Several standardized scoring systems to determine the need for an MTP have been developed and implemented with varying levels of success. The Assessment of Blood Consumption (ABC), 38 which is supported by the Trauma Quality Improvement Program, 40 assigns a numeric value of 0 or 1 to the following criteria: penetrating mechanism, presence of free fluid on focused assessment with sonography in trauma, initial emergency department systolic blood pressure of less than 90 mm Hg, and initial emergency department heart rate of 120 beats/min or more.…”

Section: Massive Transfusion Protocolsmentioning

confidence: 99%

“…The Assessment of Blood Consumption (ABC), 38 which is supported by the Trauma Quality Improvement Program, 40 assigns a numeric value of 0 or 1 to the following criteria: penetrating mechanism, presence of free fluid on focused assessment with sonography in trauma, initial emergency department systolic blood pressure of less than 90 mm Hg, and initial emergency department heart rate of 120 beats/min or more. [38][39][40] A score of 2 predicts the need for massive transfusion. 41 The ABC is a valid instrument for predicting the need for massive transfusion early in the care of a patient, with patients correctly classified 84% to 87% of the time.…”

Section: Massive Transfusion Protocolsmentioning

confidence: 99%

Contemporary Transfusion Science and Challenges

Passerini

2019

AACN Advanced Critical Care

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Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.

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The use of ABC score in activation of massive transfusion: The yin and the yang

Abstract: Prognostic, level III.

Cited by 23 publications

References 11 publications

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

Contemporary Transfusion Science and Challenges

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