title: Early risk stratification of patients with major trauma requiring massive blood transfusion.
abstract: BACKGROUND
  There is limited evidence to guide the recognition of patients with massive, uncontrolled hemorrhage who require initiation of a massive transfusion (MT) protocol.
  
  
  OBJECTIVE
  To risk stratify patients with major trauma and to predict need for MT.
  
  
  METHODS
  Retrospective analysis of an administrative trauma database of major trauma patients. A REGIONAL TRAUMA CENTRE: A regional trauma centres in Hong Kong.
  
  
  METHODS
  Patients with Injury Severity Score ≥ 9 and age ≥ 12 years were included. Burn patients, patients with known severe anemia and renal failure, or died within 24h were excluded.
  
  
  METHODS
  Delivery of ≥ 10 units of packed red blood cells (RBC) within 24h.
  
  
  RESULTS
  Between 01/01/2001 and 30/06/2009, 1891 patients met the inclusion criteria. 92 patients required ≥ 10 units RBC within 24h. Seven variables which were easy to be measured in the ED and significantly predicted the need for MT are heart rate ≥ 120/min; systolic blood pressure ≤ 90 mm Hg; Glasgow coma scale ≤ 8; displaced pelvic fracture; CT scan or FAST positive for fluid; base deficit >5 mmol/L; hemoglobin ≤ 7 g/dL; and hemoglobin 7.1-10 g/dL. At a cut off of ≥ 6, the overall correct classification for predicting need for MT was 96.9%, with a sensitivity of 31.5% and specificity of 99.7%, and an incidence of MT of 82.9%. The area under the curve was 0.889.
  
  
  CONCLUSIONS
  A prediction rule for determining an increased likelihood for the need for massive transfusion has been derived. This needs validation in an independent data set.
authors: Department of Accident and Emergency Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong. thrainer@cuhk.edu.hk
authors: Timothy H
authors: TH
authors: Rainer
authors: Anthony M-H
authors: AM
authors: Ho
authors: Janice H H
authors: JH
authors: Yeung
authors: Nai Kwong
authors: NK
authors: Cheung
authors: Raymond S M
authors: RS
authors: Wong
authors: Ning
authors: N
authors: Tang
authors: Siu Keung
authors: SK
authors: Ng
authors: George K C
authors: GK
authors: Wong
authors: Paul B S
authors: PB
authors: Lai
authors: Colin A
authors: CA
authors: Graham
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014947:Wounds and Injuries / Q000150:complications