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

BackgroundPrediction 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.Methods and FindingsAn observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10U of packed red blood cells in the first 24h and obesity as a BMI≥30kg/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.ConclusionsObesity 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.

Viscoelastic Tissue Plasminogen Activator Challenge Predicts Massive Transfusion in 15 Minutes

“…The TASH score had a high AUC that is consistent with previously reported studies (5, 25). However, the TASH score requires imaging and arterial blood gas measurements, although the creators of the TASH score claimed these variables are available within 15 minutes of ED arrival compared to the 40 minutes required for an INR test (26).…”

Application of a recursive partitioning decision tree algorithm for the prediction of massive transfusion in civilian trauma: the MTPitt prediction tool

“…The sample size used for training and validation of the decision trees was also smaller than that used for development and validation of other massive transfusion prediction scores, such as ABC and TASH, perhaps explaining the lack of power to detect differences in the balanced accuracy among the various prediction tools . In addition, the results of this study reflect the RBC transfusion practices in trauma patients at a single institution, while the ABC and TASH have been externally validated at several institutions around the world . The decision trees generated in this study will, therefore, need to be validated in larger patient cohorts, including those at other institutions.…”

“…9,10 In addition, the results of this study reflect the RBC transfusion practices in trauma patients at a single institution, while the ABC and TASH have been externally validated at several institutions around the world. [31][32][33] The decision trees generated in this study will, therefore, need to be validated in larger patient cohorts, including those at other institutions. The differences in some of the demographic, clinical and laboratory parameters between the training and validation cohorts, however, suggest that the decision trees may be robust to differences in trauma patient populations at other institutions.…”

Diagnostic performance of prothrombin time point‐of‐care to detect acute traumatic coagulopathy on admission: experience of 522 cases in trauma center

“…After admission, all patients received during study period a standardized clinical and sonographic workup according to European Trauma Guidelines . Massive transfusion risk was specifically evaluated by TASH score criteria, injuries assessment, hemodynamic variables, and the consideration of surgical bleeding . As at many centers, a high TASH score triggered the local massive transfusion protocol using balanced ratio pack.…”