Early Prediction of Massive Transfusion in Trauma: Simple as ABC (Assessment of Blood Consumption)?

TLDR

Massive transfusion occurs in about 3 % of civilian and 8 % of military trauma patients, yet most centers lack a standardized initiation policy. The study aimed to validate existing massive transfusion scoring systems and compare them to a simplified non‑laboratory ABC score. Using a retrospective cohort of 596 level‑I adult trauma patients from July 2005 to June 2006, the authors calculated TASH and McLaughlin scores per published methods and assigned ABC scores based on four non‑weighted parameters, then compared the systems using AUROC. The MT rate was 12.4 %, and TASH, McLaughlin, and ABC scores all had AUROC values around 0.84; an ABC score ≥ 2 yielded 75 % sensitivity, 86 % specificity, and 85 % correct classification, demonstrating that the simple ABC score is as accurate as the more complex scores.

Abstract

Massive transfusion (MT) occurs in about 3% of civilian and 8% of military trauma patients. Although many centers have implemented MT protocols, most do not have a standardized initiation policy. The purpose of this study was to validate previously described MT scoring systems and compare these to a simplified nonlaboratory dependent scoring system (Assessment of Blood Consumption [ABC] score).Retrospective cohort of all level I adult trauma patients transported directly from the scene (July 2005 to June 2006). Trauma-Associated Severe Hemorrhage (TASH) and McLaughlin scores calculated according to published methods. ABC score was assigned based on four nonweighted parameters: penetrating mechanism, positive focused assessment sonography for trauma, arrival systolic blood pressure of 90 mm Hg or less, and arrival heart rate > or = 120 bpm. Area under the receiver operating characteristic curve (AUROC) used to compare scoring systems.Five hundred ninety-six patients were available for analysis; and the overall MT rate of 12.4%. Patients receiving MT had higher TASH (median, 6 vs. 13; p < 0.001), McLaughlin (median, 2.4 vs. 3.4; p < 0.001) and ABC (median, 1 vs. 2; p < 0.001) scores. TASH (AUROC = 0.842), McLaughlin (AUROC = 0.846), and ABC (AUROC = 0.842) scores were all good predictors of MT, and the difference between the scores was not statistically significant. ABC score of 2 or greater was 75% sensitive and 86% specific for predicting MT (correctly classified 85%).The ABC score, which uses nonlaboratory, nonweighted parameters, is a simple and accurate in identifying patients who will require MT as compared with those previously published scores.