Comparison of massive and emergency transfusion prediction scoring systems after trauma with a new Bleeding Risk Index score applied in-flight

Abstract

BACKGROUND Assessment of blood consumption (ABC), shock index (SI), and Revised Trauma Score (RTS) are used to estimate the need for blood transfusion and triage. We compared Bleeding Risk Index (BRI) score calculated with trauma patient noninvasive vital signs and hypothesized that prehospital BRI has better performance compared with ABC, RTS, and SI for predicting the need for emergent and massive transfusion (MT). METHODS We analyzed 2-year in-flight data from adult trauma patients transported directly to a Level I trauma center via helicopter. The BRI scores 0 to 1 were derived from continuous features of photoplethymographic and electrocardiographic waveforms, oximetry values, blood pressure trends. The ABC, RTS, and SI were calculated using admission data. The area under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) was calculated for predictions of critical administration threshold (CAT, ≥3 units of blood in the first hour) or MT (≥10 units of blood in the first 24 hours). DeLong’s method was used to compare AUROCs for different scoring systems. p < 0.05 was considered statistically significant. RESULTS Among 1,396 patients, age was 46.5 ± 20.1 years (SD), 67.1% were male. The MT rate was 3.2% and CAT was 7.6%, most (92.8%) were blunt injury. Mortality was 6.6%. Scene arrival to hospital time was 35.3 ± (10.5) minutes. The BRI prediction of MT with AUROC 0.92 (95% CI, 0.89–0.95) was significantly better than ABC, SI, or RTS (AUROCs = 0.80, 0.83, 0.78, respectively; 95% CIs 0.73–0.87, 0.76–0.90, 0.71–0.85, respectively). The BRI prediction of CAT had an AUROC of 0.91 (95% CI, 0.86–0.94), which was significantly better than ABC (AUROC, 077; 95% CI, 0.73–0.82) or RTS (AUROC, 0.79; 95% CI, 0.74–0.83) and better than SI (AUROC, 0.85; 95% CI, 0.80–0.89). The BRI score threshold for optimal prediction of CAT was 0.25 and for MT was 0.28. CONCLUSION The autonomous continuous noninvasive patient vital signs–based BRI score performs better than ABC, RTS, and SI predictions of MT and CAT. Bleeding Risk Index does not require additional data entry or expert interpretation. LEVEL OF EVIDENCE Prognostic test, level III.

Rapid prediction of secondary neurologic decline after traumatic brain injury: a data analytic approach

“…Further, these models do not represent prescriptive tools; they are capable of providing a risk score for ND but do not suggest a management strategy. This is in contrast to previous work by our group predicting the need for massive transfusion based on early physiologic data 15 , 35 . At this time, the ND prediction results simply provide early warning notification for near future care planning.…”

“…Our physiologic variables included several calculated features derived from transfer learning to estimate the likelihood of clinical variables including GCS and ISS so that the decision support tools could run in a real time automated manner without losing important clinical information. The estimated GCS variables were developed from a large trauma cohort of approximately 28,000 patients 35 , 36 . This is the first time it has been applied to a TBI-specific population.…”

“…To address many of these shortcomings, we have begun a more inclusive prospective clinical validation trial (NCT: NCT05084352). Future efforts also may explore the use of ND physiologic prediction models in the pre-hospital setting 16 , 35 .…”

“…However, adding these variables requires manual evaluation with clinical expertise. To build a fully automated physiologic model, we created GCS and Injury Severity Score (ISS) 20 estimation models that use only VS variables, derived from a set of non-overlapping patient data collected prior to this study 35 , 36 . These models were used to generate additional variable inputs for ND prediction models, namely, model outputs for the prediction of specific GCS and ISS scores 36 .…”

Prehospital continuous vital signs predict need for resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy prehospital continuous vital signs predict resuscitative endovascular balloon occlusion of the aorta

“…Penetrating injury was seen in 7% of patients, median ISS was 10 [IQR 5-17], and mortality was 7%. A total of 20 patients underwent REBOA (8) or RT (10) or both (2). These patients were more likely to be men (90% vs. 68%, p < 0.01), have suffered a penetrating injury (25% vs. 6%, p = 0.001), have a with higher ISS (29 vs. 10, p < 0.001) and a higher mortality (50% vs. 6%, p < 0.001).…”