Prediction of massive bleeding in a prehospital setting: Validation of six scoring systems

Terceros-Almanza, L.J.; García-Fuentes, C.; Bermejo-Aznárez, S.; Portillo, Ivan; Mudarra-Reche, C.; Domínguez-Aguado, H.; Viejo-Moreno, Rubén; Barea‐Mendoza, Jesús Abelardo; Gómez-Soler, R.; Casado-Flores, I.; Chico‐Fernández, Mario

doi:10.1016/j.medine.2019.02.001

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…Overall, our results show that only pFB and TEG‐MA were moderately associated with severe bleeding, although their predictive ability was far from optimal. This is in line with the findings of previous publications, which produced heterogeneous results regarding the predictive value of SLTs and viscoelastic tests for bleeding in critically ill patients with coagulopathy. Differences in design, clinical scenarios, and the time of sampling could partially explain these controversial results.…”

Section: Discussionsupporting

confidence: 92%

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Casado-Méndez

Fernández-Pacheco

Arellano-Orden

et al. 2019

Int J Lab Hematology

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Introduction This study aimed to ascertain the associations of thromboelastography (TEG®) and standard laboratory test (SLTs) values with the presence of bleeding in critically ill patients with known coagulopathy. Methods Three groups of coagulopathic patients with (a) hepatic failure, (b) postoperative period after prolonged cardiac surgery, and (c) complex abdominal surgery with sepsis were prospectively included in this study. On intensive care unit (ICU) admission, patients were stratified into two groups according to whether they had major bleeding (MB) (evident overt bleeding, important bleeding apparent on imaging studies, and/or need for moderate‐massive blood transfusion and hemodynamic instability). Blood samples were drawn for the SLTs (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count, and fibrinogen level [Clauss]) and TEG whole blood coagulation assays. Receiver operating characteristic (ROC) curves were generated to determine the efficiency of TEG and SLTs for detecting bleeding. The correlations between SLTs and TEG parameters with similar coagulation profiles were evaluated by Spearman rank‐order analysis. Results Eighty‐three patients were included, and bleeding was confirmed in 45 (54%). The fibrinogen level demonstrated the best accuracy for detecting bleeding with an area under the curve and 95% confidence intervals [AUC (95% CI)] of 0.74 (0.63‐0.85) with the best cutoff value of ≤ 2 g/L. Regarding TEG‐MA, the AUC (CI) obtained with the optimal cutoff value of ≤ 51 mm was 0.68 (0.56‐0.80). Conclusions Both conventional clotting tests and TEG values were poorly associated with bleeding in this critically ill cohort of patients with coagulopathy.

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Section: Discussionsupporting

confidence: 92%

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Casado-Méndez

Fernández-Pacheco

Arellano-Orden

et al. 2019

Int J Lab Hematology

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“…The use of this protocol is a local choice and has the main advantage of relying only on pre‐hospital variables, simple to evaluate, and usually collected and transmitted by pre‐hospital teams. Other predictive scores for massive transfusion have been published and compared with each other 18–21,38 . Unfortunately, these scores frequently include post‐admission parameters, making it difficult to anticipate LBP prescription.…”

Section: Discussionmentioning

confidence: 99%

“…Other predictive scores for massive transfusion have been published and compared with each other. [18][19][20][21]38 Unfortunately, these scores frequently include post-admission parameters, making it difficult to anticipate LBP prescription.…”

Section: Discussionmentioning

confidence: 99%

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Step by step transfusion timeline and its challenges in trauma: A retrospective study in a level one trauma center

Boyé

Libert

et al. 2022

Transfusion

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Background Hemorrhagic shock is the leading cause of preventable early death in trauma patients. Transfusion management is guided by international guidelines promoting early and aggressive transfusion strategies. This study aimed to describe transfusion timelines in a trauma center and to identify key points to performing early and efficient transfusions. Methods This is a monocentric retrospective study of 108 severe trauma patients, transfused within the first 48 h and hospitalized in an intensive care unit between January 2017 and May 2019. RESULTS One hundred and eight patients were transfused with 1250 labile blood products. Half of these labile blood products were transfused within 3 h of admission and consumed by 26 patients requiring massive transfusion (≥4 red blood cells [RBC] within 1 h). Among these, the median delay from patient's admission to labile blood products prescription was −11 min (−34 to −1); from admission to delivery of labile blood products was 1 min (−20 to 16); and from admission to first transfusion was 20 min (7–37) for RBC, 26 min (13–38) for plasma, and 72 min (51–103) for platelet concentrates. The anticipated prescription of labile blood products and the use of massive transfusion packs and lyophilized plasma units were associated with earlier achievement of high transfusion ratios. Conclusion This study provides detailed data on the transfusion timelines and composition, from prescription to initial transfusion. Transfusion anticipation, use of preconditioned transfusion packs including platelets, and lyophilized plasma allow rapid and high‐ratio transfusion practices in severe trauma patients.

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“…Colleagues from Spain conducted a retrospective analysis in 2019 on the topic of prehospital prediction of massive bleeding using scoring systems. The best results were achieved by a score that had at least 6 variables, including BE, serum Hb, or FAST performed during transport to the ED: Emergency Transfusion Score (ETS; AUC 0.85), Trauma Associated Severe Haemorrhage (TASH) and the Prince of Wales Hospital score (AUC 0.82) [21]. Since many pre-hospital systems do not use imaging and laboratory complement, we focused on scoring systems using readily available vital signs values.…”

Section: Discussionmentioning

confidence: 99%

Prediction of pre-hospital blood transfusion in trauma patients based on scoring systems

Plodr¹,

Berková²,

Hyspler³

et al. 2022

Preprint

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Background Pre-hospital blood transfusion (PHBT) is a safe and gradually expanding procedure applied in trauma patients. A proper decision to activate PHBT in presently limited diagnostic options at the site of incident poses a challenge for pre-hospital crews. The purpose of this study was to compare the selected scoring systems and to determine whether they can be used as a valid tool in identifying patients with PHBT requirement. Methods A retrospective single-center study was conducted between June 2018 and December 2020. Overall, 385 patients (aged [median; IQR]: 44; 24–60; 73% males) were included in this study. The values of six selected scoring systems were calculated in all patients. To determine accuracy of each score for the prediction of PHBT, the Receiver Operating Characteristic (ROC) analysis was used and to measure of association, the odds ratio with 95% confidence intervals was count. Results Regarding the proper indication of PHBT, shock index (SI), reversed shock index (rSI) and pulse pressure (PP) revealed the highest value of AUC and sensitivity/specificity ratio (SI: AUC 0,88; 95% CI 0,82 − 0,93; rSI: AUC 0,88; 95% CI 0,82 − 0,94; PP: AUC 0,85 with 95% CI 0,79 − 0,91). Conclusion Shock index, reversed shock index and pulse pressure are suitable tools for predicting PHBT in trauma patients.

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Prediction of massive bleeding in a prehospital setting: Validation of six scoring systems

Cited by 9 publications

References 28 publications

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Step by step transfusion timeline and its challenges in trauma: A retrospective study in a level one trauma center

Prediction of pre-hospital blood transfusion in trauma patients based on scoring systems

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