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) systolic blood pressure in mm Hg
(2) diastolic blood pressure in mm Hg
(3) heart rate in beats per minute
(4) respiratory rate in breaths per minute
(5) SpO2 in percent
(6) motor component of the Glasgow Coma Scale, from 1 to 6
(7) penetrating injury
|
Parameter |
Finding |
Points |
|
systolic blood pressure |
0 to 8 |
1 |
|
|
9 to 23 |
13 |
|
|
24 to 38 |
12 |
|
|
39 to 53 |
11 |
|
|
54 to 68 |
10 |
|
|
69 to 83 |
9 |
|
|
84 to 98 |
8 |
|
|
99 to 114 |
7 |
|
|
115 to 129 |
6 |
|
|
130 to 144 |
5 |
|
|
145 to 159 |
4 |
|
|
160 to 174 |
3 |
|
|
175 to 189 |
2 |
|
|
190 to 205 |
1 |
|
|
>= 206 |
0 |
|
diastolic blood pressure |
0 to 10 |
0 |
|
|
11 to 29 |
1 |
|
|
30 to 48 |
2 |
|
|
49 to 67 |
3 |
|
|
68 to 87 |
4 |
|
|
88 to 106 |
5 |
|
|
107 to 125 |
6 |
|
|
126 to 144 |
7 |
|
|
145 to 163 |
8 |
|
|
164 to 183 |
9 |
|
|
184 to 200 |
10 |
|
|
>= 203 |
11 |
|
heart rate |
0 to 19 |
0 |
|
|
20 to 58 |
1 |
|
|
59 to 96 |
2 |
|
|
97 to 135 |
3 |
|
|
136 to 173 |
4 |
|
|
174 to 212 |
5 |
|
|
>= 213 |
6 |
|
respiratory rate |
0 to 13 |
0 |
|
|
14 to 39 |
1 |
|
|
40 to 66 |
2 |
|
|
>= 67 |
3 |
|
SpO2 |
84 to 100% |
0 |
|
|
29 to 83% |
1 |
|
|
0 to 28% |
2 |
|
motor GCS |
5 or 6 |
0 |
|
|
2 to 4 |
1 |
|
|
1 |
2 |
|
penetrating trauma |
no |
0 |
|
|
yes |
1 |
where:
• Some findings (like SpO2 less than 29%) are infrequent.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score:39
• The higher the score the greater the likelihood of massive transfusion.
• The optimal cutoff was 12 which has a sensitivity of 0.78 and specificity of 0.62.
Performance:
• The area under the ROC curve is 0.75.
Specialty: Clinical Laboratory
