Nakamura et al identified risk factors for massive transfusion in an adult who has had severe blunt trauma. These can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Japan.
Patient selection: adult with blunt trauma with ISS >= 16
Exclusions: cardiac arrest, burns, cervical spine injury not caused by high-energy accident, pregnancy or cirrhosis
Parameters:
(1) heart rate in beats per minute
(2) systolic blood pressure in mm Hg
(3) Glasgow coma score (GCS)
(4) plasma fibrinogen in mg/dL
|
Parameter
|
Finding
|
Points
|
|
heart rate
|
< 100 beats per minute
|
0
|
|
|
>= 100 beats per minute
|
1
|
|
systolic blood pressure
|
> 120 mm Hg
|
0
|
|
|
<= 120 mm Hg
|
1
|
|
Glasgow coma score
|
13 to 15
|
0
|
|
|
3 to 12
|
1
|
|
plasma fibrinogen
|
> 190 mg/dL
|
0
|
|
|
<= 190 mg/dL
|
1
|
number of risk factors =
= SUM(points for all 4 risk factors)
Interpretation:
• minimum number: 0
• maximum number: 4
Performance:
• The sensitivity of the individual parameters ranged from 55 to 62%.
• The specificity of the individual parameters ranged from 64 to 80%.
Risk factors for low fibrinogen:
(1) low base excess (acidosis)
(2) increasing time of specimen collection from injury
(3) young age
(4) male sex
(5) increasing ISS
