Nunez et al developed the ABC (Assessment of Blood Composition) Score to identify a trauma patient who requires massive transfusion. The authors are from Vanderbilt University and the Tennessee Valley VA Medical Center in Nashville.
Parameters:
(1) penetrating trauma
(2) systolic blood pressure on admission to the Emergency Department (ED)
(3) heart rate on admission to the ED
(4) FAST findings (Focused Assessment with Sonography for Trauma)
Parameter
Finding
Points
penetrating trauma
absent
0
present
1
systolic blood pressure
> 90 mm Hg
0
<= 90 mm Hg
1
heart rate
< 120 beats per minute
0
>= 120 beats per minute
1
FAST
negative
0
positive
1
total ABC score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The cutoff for massive transfusion was a score >= 2.
Performance:
• For a cutoff of >= 1, the sensitivity was 95% and specificity 56%.
• For a cutoff of >= 2, the sensitivity was 75% and specificity 86%.
• While both cutoffs had equivalent Youden scores, the cutoff of >= 2 correctly classified 84% of cases vs 61% for a cutoff >= 1 (which causes some concern about the accuracy of the sensitivity and specificity figures.).
• The AUC was 0.842.
• The massive transfusion rate of 12.4%
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