title: Relationship between Obesity and Massive Transfusion Needs in Trauma Patients, and Validation of TASH Score in Obese Population: A Retrospective Study on 910 Trauma Patients.
abstract: BACKGROUND
  Prediction of massive transfusion (MT) is challenging in management of trauma patients. However, MT and its prediction were poorly studied in obese patients. The main objective was to assess the relationship between obesity and MT needs in trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT.
  
  
  RESULTS
  An observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10 U of packed red blood cells in the first 24h and obesity as a BMI≥30 kg/m². Between January 2008 and December 2012, 119 obese and 791 non-obese trauma patients were included. The rate of MT was 10% (94/910) in the whole population. The MT rate tended to be higher in obese patients than in non-obese patients: 15% (18/119, 95%CI 9‒23%) versus 10% (76/791, 95%CI 8‒12%), OR, 1.68 [95%CI 0.97‒2.92], p = 0.07. After adjusting for Injury Severity Score (ISS), obesity was significantly associated with MT rate (OR, 1.79[95%CI 1.00‒3.21], p = 0.049). The TASH score was higher in the obese group than in the non-obese group: 7(4-11) versus 5(2-10) (p<0.001). The area under the ROC curves of the TASH score in predicting MT was very high and comparable between the obese and non-obese groups: 0.93 (95%CI, 0.89‒0.98) and 0.94 (95%CI, 0.92‒0.96), respectively (p = 0.80). The grey zone ranged respectively from 10 to 13 and from 9 to 12 in obese and non obese patients, and allowed separating patients at low, intermediate or high risk of MT using the TASH score.
  
  
  CONCLUSIONS
  Obesity was associated with a higher rate of MT in trauma patients. The predictive performance of the TASH score and the grey zones were robust and comparable between obese and non-obese patients.
authors.affiliation: Trauma Intensive Care & Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.|Intensive Care Unit & Anesthesiology Department, Saint-Eloi University Hospital, Montpellier, France.|INSERM U1046 Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Trauma Intensive Care & Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Deras
authors.affiliation: Trauma Intensive Care & Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Orianne
authors.initials: O
authors.lastname: Martinez
authors.affiliation: INSERM U1046 Montpellier, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Latry
authors.affiliation: Intensive Care Unit & Anesthesiology Department, Saint-Eloi University Hospital, Montpellier, France.|INSERM U1046 Montpellier, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Trauma Intensive Care & Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
authors.affiliation: Trauma Intensive Care & Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Charbit
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012372:ROC Curve; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult