Chow et al reported the Algorithm Examining the Risk of Massive Transfusion (ALERT) Scores for identifying a patient requiring massive transfusion. There are scores for prehospital and admission states. The authors are from George Washington University, University of Maryland and the University of Oklahoma.
Patient selection: traumatically injured patient prior to arrival at the trauma center
Parameters:
(1) prehospital systolic blood pressure (SBP) in mm Hg
(2) prehospital diastolic blood pressure (DBP) in mm Hg
(3) admission systolic blood pressure in mm Hg
(4) admission heart rate in beats per minute
(5) admission respiratory rate in breaths per minute
(6) admission temperature in °C
(6) admission Glasgow Coma Scale, from 3 to 15
(7) FAST exam
|
Parameter |
Finding |
Points |
|
prehospital SBP |
0 to 16 |
7 |
|
|
17 to 47 |
6 |
|
|
48 to 78 |
5 |
|
|
79 to 109 |
4 |
|
|
110 to 141 |
3 |
|
|
142 to 172 |
2 |
|
|
173 to 203 |
1 |
|
|
>= 204 |
0 |
|
prehospital DBP |
0 to 15 |
0 |
|
|
16 to 44 |
1 |
|
|
45 to 74 |
2 |
|
|
75 to 103 |
3 |
|
|
104 to 132 |
4 |
|
|
133 to 162 |
5 |
|
|
163 to 191 |
6 |
|
|
>= 192 |
7 |
|
admission SBP |
0 to 51 |
12 |
|
|
52 to 66 |
11 |
|
|
67 to 81 |
10 |
|
|
82 to 96 |
9 |
|
|
97 to 110 |
8 |
|
|
111 to 125 |
7 |
|
|
126 to 140 |
6 |
|
|
141 to 154 |
5 |
|
|
155 to 169 |
4 |
|
|
170 to 184 |
3 |
|
|
185 to 199 |
2 |
|
|
200 to 213 |
1 |
|
|
>= 214 |
0 |
|
admission heart rate |
0 to 11 |
0 |
|
|
12 to 33 |
1 |
|
|
34 to 54 |
2 |
|
|
55 to 76 |
3 |
|
|
77 to 98 |
4 |
|
|
99 to 120 |
5 |
|
|
121 to 141 |
6 |
|
|
142 to 163 |
7 |
|
|
164 to 185 |
8 |
|
|
186 to 207 |
9 |
|
|
>= 208 |
10 |
|
admission respiratory rate |
0 to 9 |
0 |
|
|
10 to 27 |
1 |
|
|
28 to 45 |
2 |
|
|
46 to 63 |
3 |
|
|
>= 64 |
4 |
|
temperature in °C |
<= 33.1 |
10 |
|
|
33.2 to 34 |
9 |
|
|
34.1 to 34.9 |
8 |
|
|
35 to 35.8 |
7 |
|
|
35.9 to 36.8 |
6 |
|
|
36.9 to 37.7 |
5 |
|
|
37.8 to 38.6 |
4 |
|
|
38.7 to 39.5 |
3 |
|
|
39.6 to 40.4 |
2 |
|
|
40.5 to 41.3 |
1 |
|
|
>= 41.4 |
0 |
|
admission GCS |
3 |
2 |
|
|
4 to 10 |
1 |
|
|
11 to 15 |
0 |
|
FAST exam |
negative |
0 |
|
|
positive |
4 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 47
• The higher the score the greater the likelihood of massive transfusion.
• A score >= 12 had a sensitivity of 0.78 and specificity of 0.62.
• A score >= 15 had a sensitivity of 0.25 and specificity of 0.96, with 89% correctly classified.
• A score >= 20 was 100% specific for massive transfusion (yet correct classification is reported as 90%).
Performance:
• The area under the ROC curve is 0.91, although this seems unusual based on the sensitivities and specificities reported.
Specialty: Clinical Laboratory
