Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry

Journal of Clinical Medicine

Marc Maegele¹  Rolf Lefering¹  Shailvi Gupta²  Claudia Abbati³  Osvaldo Chiara³  Stefania Cimbanassi³  Fabrizio Sammartano³  SaraGiulia Cornero³ 

[1] Cologne-Merheim Medical Center, Department for Trauma and Orthopedic Surgery, Institute for Research in Operative Medicine, University Witten/Herdecke, 51109 Köln, Germany;R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD 21201, USA;Trauma Team and General Surgery ASST Niguarda Milano, Department of Pathophysiology and Transplantation, University of Milano, 20125 Milano, Italy;

关键词: trauma;    bleeding;    blood transfusion;    score;   

DOI  :  10.3390/jcm9103235

来源: DOAJ

【 摘 要 】

Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT−). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage.

【 授权许可】

Unknown