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Vol. 43. Num. 3.
Pages 129-192 (April 2019)
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Vol. 43. Num. 3.
Pages 129-192 (April 2019)
Original
DOI: 10.1016/j.medine.2019.02.001
Prediction of massive bleeding in a prehospital setting: Validation of six scoring systems
Predicción de hemorragia masiva a nivel extrahospitalario: validación de seis escalas
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L.J. Terceros-Almanzaa,
Corresponding author
luchoter000@hotmail.com

Corresponding author.
, C. García-Fuentesa, S. Bermejo-Aznáreza, I.J. Prieto del Portilloa, C. Mudarra-Rechea, H. Domínguez-Aguadoa, R. Viejo-Morenoa, J. Barea-Mendozaa, R. Gómez-Solerb, I. Casado-Floresb, M. Chico-Fernándeza
a Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Spain
b Servicio de Asistencia Municipal de Urgencia y Rescate – SAMUR-Protección Civil, Spain
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Tables (3)
Table 1. Variables and scores of the predictive scales.
Table 2. Demographic and clinical characteristics of the study population.
Table 3. Comparison of the predictive scales.
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Abstract
Objective

To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting.

Design

Retrospective cohort.

Setting

Prehospital attention of patients with severe trauma.

Subjects

Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid.

Variables

To validate: 1. Trauma Associated Severe Haemorrhage Score. 2. Assessment of Blood Consumption Score. 3. Emergency Transfusión Score. 4. Índice de Shock. 5. Prince of Wales Hospital/Rainer Score. 6. Larson Score.

Results

548 subjects were studied, 76.8% (420) were male, median age was 38 (interquartile range [IQR]: 27–50). Injury Severity Score was 18 (IQR: 9–29). Blunt trauma represented 82.5% (452) of the cases. Overall, frequency of MB was 9.2% (48), median intensive care unit admission days was 2.1 (IQR: 0.8–6.2) and hospital mortality rate was 11.2% (59). Emergency Transfusión Score had the highest precisions (AUC 0.85), followed by Trauma Associated Severe Haemorrhage score and Prince of Wales Hospital/Rainer Score (AUC 0.82); Assessment of Blood Consumption Score was the less precise (AUC 0.68).

Conclusion

In the prehospital setting the application of any of the six scoring systems predicts the presence of massive hemorrhage and allows the activation of massive transfusion protocols while the patient is transferred to a hospital.

Keywords:
Hemorrhagic shock
Massive bleeding
Massive transfussion
Damage control resuscitation
Resumen
Objetivo

Validar a nivel extrahospitalario la capacidad diagnóstica de seis escalas de predicción para hemorragia masiva.

Diseño

Cohorte retrospectiva.

Ámbito

Atención extrahospitalaria del paciente con enfermedad traumática grave.

Participantes

Pacientes mayores de 15 años, que han sufrido un trauma grave (definido por los criterios de código 15), atendidos en el medio extrahospitalario por un servicio de atención sanitaria de emergencias desde enero de 2010 hasta diciembre de 2015 y trasladados a un centro hospitalario de alta complejidad en Madrid.

Variables de interés principales

Se validaron las siguientes escalas: 1. Trauma Associated Severe Haemorrhage score. 2. Assessment of Blood Consumption Score. 3. Emergency Transfusion Score. 4. Índice de Shock. 5. Prince of Wales Hospital/Rainer Score. 6. Larson Score.

Resultados

Se estudiaron 548 pacientes, el 76,8% (420) fueron hombres, una edad mediana de 38 (rango intercuartil [RIC]: 27-50). Injury Severity Score de 18 (RIC: 9-29). El trauma cerrado fue el 82,5% (452). La frecuencia global de HM fue de 9,2% (48), días de estancia en UCI de 2,1 (RIC: 0,8 - 6,2) y una mortalidad hospitalaria del 11,2% (59). La escala con mayor precisión fue la Emergency Transfusion Score (AUC 0,85), en segundo lugar se encuentran Trauma Associated Severe Haemorrhage y Prince of Wales Hospital/Rainer (AUC 0,82); la escala con menor precisión Assessment of Blood Consumption (AUC 0,68).

Conclusiones

A nivel extrahospitalario la aplicación de cualquiera de las seis escalas predice la presencia de hemorragia masiva y permite la activación de los protocolos de transfusión masiva mientras el paciente es trasladado a un centro hospitalario.

Palabras clave:
Shock hemorrágico
Hemorragia masiva
Transfusión masiva
Resucitación con control de daños

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