Early risk stratification of patients with major trauma requiring massive blood transfusion

Background There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion (MT) protocol. Objective To risk stratify patients with major trauma and to predict need for MT. Designs Retrospective analysis of an administrative trauma database of major trauma patients. A regional trauma Centre A regional trauma centres in Hong Kong. Patients Patients with Injury Severity Score ≥9 and age ≥12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24 h were excluded. Main outcome measures Delivery of ≥10 units of packed red blood cells (RBC) within 24 h. Results Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥10 units RBC within 24 h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥120/min; systolic blood pressure ≤90 mmHg; Glasgow coma scale ≤8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5 mmol/L; hemoglobin ≤7 g/dL; and hemoglobin 7.1–10 g/dL. At a cut off of ≥6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889. Conclusion A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set.