Larson et al identified 4 physiologic markers seen on a arrival of a combat casualty associated with the need for massive transfusion. These are objective findings that can be helpful in identifying a patient who may require more aggressive resuscitation. The authors are from the United States Army Institute of Surgical Research at Fort Sam Houston in Texas, Children’s Medical Center in Harford, and the University of Texas Health Science Center in Houston.
Patient selection: combat casualty
Parameters seen on arrival:
(1) heart rate
(2) systolic blood pressure
(3) base deficit
(4) hemoglobin
|
Parameter |
Finding |
Points |
|
heart rate |
<= 110 beats per minute |
0 |
|
|
> 110 beats per minute |
1 |
|
systolic blood pressure |
>= 110 mm Hg |
0 |
|
|
< 110 mm Hg |
1 |
|
base deficit |
> -6 |
0 |
|
|
<= -6 |
1 |
|
hemoglobin |
> 11 g/dL |
0 |
|
|
<= 11 g/dL |
1 |
where:
• The heart rate was originally > 105 beats per minute but was raised to be easier to remember.
• Base deficit is the opposite of base excess. A more negative base deficit indicates a more positive base excess. Since acidosis is typically the problem in trauma the worse prognosis should be for a more negative base excess.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the more likely that the patient will require massive transfusion.
|
Total Score |
Massive Transfusion |
|
0 |
16% |
|
>=1 |
44% |
|
>= 2 |
54% |
|
>= 3 |
64% |
|
>= 4 |
74% |
If this data is dissected (total number of subjects 1124)
|
Score |
Number with Score |
Number Receiving Massive Transfusion |
|
0 |
260 |
41 (16%) |
|
1 |
326 |
90 (28%) |
|
2 |
266 |
116 (44%) |
|
3 |
203 |
123 (61%) |
|
4 |
69 |
51 (74%) |
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
