Rainer et al developed a score for predicting massive transfusion (MT). The authors are from Prince of Wale Hospital (PWH) and the Chinese University of Hong Kong.
Massive transfusion was defined as requiring >= 10 units of packed RBCs within 24 hours.
Patient selection: age >= 12 years and ISS >= 9
Parameters:
(1) heart rate in the Emergency Department in beats per minute
(2) systolic blood pressure in Emergency Department in mm Hg
(3) Glasgow Coma Score (GCS)
(4) pelvic fracture
(5) abdominal CT or FAST exam
(6) base deficit in mmol/L
(7) hemoglobin in g/dL
|
Parameter |
Finding |
Points |
|---|---|---|
|
heart rate |
<= 120 beats per minute |
0 |
|
|
> 120 beats per minute |
1 |
|
systolic blood pressure |
> 90 mm Hg |
0 |
|
|
<= 90 mm Hg |
1 |
|
Glasgow Coma Score |
9 to 15 |
0 |
|
|
<= 8 |
1 |
|
pelvic fracture |
none or not displaced |
0 |
|
|
displaced |
1 |
|
abdominal CT or FAST exam |
no fluid present |
0 |
|
|
fluid present |
1 |
|
base deficit |
<= 5 mmol/L |
0 |
|
|
> 5 mmol/L |
1 |
|
hemoglobin |
> 10 g/dL |
0 |
|
|
7.1 to 10 g/dL |
1 |
|
|
<= 7.0 g/dL |
10 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• A score >= 6 indicates a patient who will probably require massive transfusion.
Performance:
• The sensitivity was 32% and specificity 100% (2 out of 3 patients requiring MT missed).
• Overall correct classification 97% (which reflects that only 5% of patients required MT).
• Area under the ROC curve 0.89.
Purpose: To identify a trauma patient who will probably require massive blood transfusion using the Prince of Wales Hospital (PWH) score.
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
Objective: risk factors, complications, selection
ICD-10: D62, T79, Z51.3,
