Article

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

Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
The Journal of trauma (Impact Factor: 2.96). 03/2009; 66(2):346-52. DOI: 10.1097/TA.0b013e3181961c35
Source: PubMed

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.

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    • "Assessment of Blood Consumption (ABC) Score [247] "
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    ABSTRACT: The early recognition and management of hemorrhage shock are among the most difficult tasks challenging the clinician during primary assessment of the acutely bleeding patient. Often with little time, within a chaotic setting, and without sufficient clinical data, a decision must be reached to begin transfusion of blood components in massive amounts. The practice of massive transfusion has advanced considerably and is now a more complete and, arguably, more effective process. This new therapeutic paradigm, referred to as damage control resuscitation (DCR), differs considerably in many important respects from previous management strategies for catastrophic blood loss. We review several important elements of DCR including immediate correction of specific coagulopathies induced by hemorrhage and management of several extreme homeostatic imbalances that may appear in the aftermath of resuscitation. We also emphasize that the foremost objective in managing exsanguinating hemorrhage is always expedient and definitive control of the source of bleeding. Copyright © 2015. Published by Elsevier Ltd.
    Blood Reviews 01/2015; 46. DOI:10.1016/j.blre.2014.12.006 · 5.45 Impact Factor
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    • "Massive transfusion is defined as transfusion of more than 10 units of blood within the first 24 h or replacement of one blood volume in a 24 h period [1] [2]. In civilian trauma, about 5% of patients undergoes massive transfusion [3] [4]. Multiple retrospective studies have suggested that aggressive resuscitation with blood products to achieve a high ratio (2:3 ratio) of plasma to red blood cells (RBC) improved survival [5] [6] [7]. "
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    • "The monitoring of traditional vital signs, including looking for tachycardia followed by hypotension as the indicator of blood loss, has been a primary method of identifying and treating patients in hemorrhagic shock [4]. In the last several years, there have also been attempts at mathematical prediction models of post traumatic bleeding such as the Assessment of Blood Consumption (ABC) Score [5], the McLaughlin Score [6], and the Trauma Assessment Severity of Hemorrhage score [7]. However, while they are based on vital signs, they also incorporate advanced modalities. "
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