Ohmori et al identified a number of risk factors for massive transfusion in an older adult with severe trauma. These can help to identify a patient who may require more aggressive management. The authors are from Kochi Health Sciences Center in Japan.
Patient selection: age >= 65 years with severe trauma
Risk factors for massive transfusion:
(1) positive FAST (odds ratio 5.6)
(2) unstable pelvic fracture (odds ratio 21.6)
(3) open fracture of the femur and/or tibia (odds ratio 12.2)
(4) pre-injury anticoagulant use (odds ratio 5.2)
(5) pre-injury antiplatelet agent use (odds ratio 3.8)
(6) shock index (odds ratio 2.7)
(7) elevated serum lactate
where:
• Use shock index >=0.77 based on Table 4.
• Use serum lactate >= 2.3 mmol/L based on Table 4.
Of interest is that initial vital signs may be normal.
