Wheeler et al reported prehospital predictors for massive transfusion in a combat casualty. These can help to identify a patient who may require more aggressive management and use of blood products. The authors are from the University of South Carolina, US Army Institute of Surgical Research, Brooke Army Medical Center, JBSA Fort Sam Houston, JBSA Lackland, Texas A&M University and the Uniformed Services University of the Health Sciences.
Patient selection: combat casualty
Predictors for a simplified model based on multivariate analysis:
(1) major amputation (odds ratio 17)
(2) application of tourniquet (odds ratio 6.7)
(3) heart rate > 120 beats per minute (tachycardia; odds ratio 8.7)
Additional predictors:
(1) mechanism of injury explosive
(2) mechanism of injury gunshot wound
(3) serious injuries by the abbreviated injury scale (AIS) to:
(3a) face
(3b) head and neck
(3c) thorax
(3d) abdominal injury
(3e) extremities
(3f) skin (? burns)
(4) systolic blood pressure < 90 mm Hg
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