Lui et al developed the dynamic massive blood transfusion (dynamic MBT) score for evaluating patients with major trauma. This can help to identify a patient who may require significant blood resources. The authors are from Tuen Men Hospital, North Lantau Hospital, Princess Margaret Hospital, Queen Elizabeth Hospital, Queen Mary Hospital and the University of Hong Kong.
Patient selection: major trauma, age > 12 years
Outcome: massive blood transfusion (>= 10 units packed red blood cells within 24 hours)
Parameters:
(1) systolic blood pressure in mm Hg
(2) heart rate in beats per minute
(3) initial hemoglobin in g/dL
(4) drop in hemoglobin in the first 2 hours in g/dL based on current and initial hemoglobins
(5) INR
(6) base deficit in mmol/L
(7) unstable pelvic fracture
(8) hemoperitoneium in FAST scan or CT
drop in hemoglobin at 2 hours =
= (initial hemoglobin) - (current hemoglobin)
|
Parameter
|
Finding
|
Points
|
|
systolic blood pressure
|
> 90 mm Hg
|
0
|
|
|
<= 90 mm Hg
|
2
|
|
heart rate
|
< 120 beats per minute
|
0
|
|
|
>= 120 beats per minute
|
2
|
|
hemoglobin
|
(initial level > 10 g/dL) AND (drop < 2 g/dL)
|
0
|
|
|
(initial 8.1 to 10 g/dL) OR (drop 2 to 3.9 g/dL)
|
2
|
|
|
(initial <= 8 g/dL) OR (drop >= 4 g/dL)
|
4
|
|
INR
|
< 1.3
|
0
|
|
|
>= 1.3
|
2
|
|
base deficit
|
< 5 mmol/L
|
0
|
|
|
5 to 9.9 mmol/L
|
2
|
|
|
>= 10 mmol/L
|
5
|
|
unstable pelvic fracture
|
absent
|
0
|
|
|
present
|
4
|
|
hemoperitoneum
|
absent
|
0
|
|
|
present
|
2
|
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The cutoff for massive transfusion was >= 6.
Performance:
• With score >= 6, the sensitivity was 78% and specificity 89%.
• The area under the ROC curve is 0.91.
