Clinical paperEarly risk stratification of patients with major trauma requiring massive blood transfusion☆
Section snippets
Background
Trauma is the leading cause of death worldwide in people under 45 years of age, is currently fifth for all ages, and is projected to become the second leading cause of death by 2020 worldwide.1, 2, 3 Exsanguination plays a critical role in 40% of these deaths and uncontrolled hemorrhage after traumatic injury is the most common cause of potentially preventable death.4, 5 Early coagulopathy, acidosis and hypothermia are also associated with increased mortality.6, 7 After the onset of injury a
Study design
Ethical approval was obtained from the joint Chinese University of Hong Kong/New Territories East Cluster Clinical Research Ethics Committee in Hong Kong to conduct a retrospective study to derive a clinical prediction rule for major trauma patients requiring massive blood transfusion. The period of study was from 1st January 2001 to 31 August 2009.
Setting
95% of the population in Hong Kong are Chinese. The Prince of Wales Hospital (PWH) is a university tertiary referral centre situated in the New
Results
Between 1st January 2001 and 30th June 2009, 4336 patients were included in the trauma database. Fig. 1 shows the selection of patients for the study. 355 patients required one or more units of packed red blood cells (range 1–54 units) of whom 125 patients required 1–5 units, 138 patients 6–9 units, and 92 (4.9%) of 1891 patients required ≥10 units within 24 h.
Table 1 shows baseline characteristics of this group. Although the majority of patients receiving a massive transfusion were either
Discussion
In this study we have derived a simple 10-point score for classifying civilian patients with major trauma likely to need a MT. Seven variables, easily measured or identified in the trauma resuscitation room were identified, and weighted scores assigned according to their odds ratios. At a cut off ≥6, the overall correct classification for predicting need for MT was 96.6%, with a specificity of 99.7% and the positive predictive value was 82.9%.
The proportion of patients requiring a MT in our
Funding
None.
Conflict of interest
None.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.02.016.