Early Predictors for Massive Transfusion in a Combat Casualty

 

Massive transfusion: >= 10 units of blood (packed or fresh whole) in the first 24 hours after admission.

 

Parameters based on admission data:

(1) hemoglobin

(2) INR

(3) mechanism of injury

Parameter	Finding	Points
hemoglobin	> 11 g/dL	0
	<= 11 g/dL	1
INR	<= 1.5	0
	> 1.5	1
mechanism of injury	penetrating	1
	other (blast, burn, etc)	0

 

where:

• The elevation in INR is usually due to a coagulopathy triggered by release of tissue thromboplastin in massive trauma.

• The odds ratio for hemoglobin was approximately 8; for INR 6 and penetrating mechanism 3.

• Most casualties had fluid resuscitation in the field and a transport time of 20-60 minutes.

 

total number of risk factors =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 3

• The risk of massive transfusion increases with the number of risk factors.