Massive Transfusion Decision Scores : Theres several scoring systems that can predict the need for massive blood transfusion in polytrauma patients 1-Assessment of Blood Consumption (ABC) Score : Developed in 2009 based on a cohort of primary civilian trauma patients. Score uses only non-laboratory and non-weighted parameters that are available during the first admission of a trauma patient. Massive transfusion (MT) defined as transfusion of ≥ 10 units of PRBC in the first 24 hours after admission. ABC score > or = 2 triggers for starting MT Penetrating Mechanism No = 0, Yes = 1 ED SBP ≤ 90 No = 0, Yes = 1 ED Heart Rate ≥ 120 No = 0, Yes = 1 Positive FAST No = 0, Yes = 1 Percentage of patients requiring a massive transfusion: ABC Score: 0 → 1% ABC Score: 1 → 10% ABC Score: 2 → 41% ABC Score: 3 → 48% ABC Score: 4 → 100% (Nunez TC et al, 2009) 2-COAST Score Prospectively validated using 1225 major trauma patients. Five Variables: 1.Entrapment 2.Temperature < 35°C 3.SBP < 100 mm Hg 4.Abdominal/Pelvic Content Injury 5.Prehospital Chest Decompression COAST score ≥ 3 defined as trigger for MT (Mitra B et al, 2011) 3-Larson Score Derived from a combat database (2003-2008) → Retrospective review of the Joint Theater Trauma Registry transfusion database for all US service personnel injured in combat during overseas contingency operations. Four Variables: 1- Heart rate 2- SBP 3- Hemoglobin 4- Base deficit (Larson CR et al, 2010) 4-McLaughlin Score Developed using a registry of combat casualty patients. Four Variables: 1- HR>105 2- SBP 6 mmol/L (+3) > 2 mmol/L (+1) -SBP < 100 mm Hg (+4) < 120 mm Hg (+1) -Heart Rate > 120 (+2) ≤ 120 (+0) - Positive FAST Yes (+3) No (+0) - Clinically Unstable Pelvic Fracture Yes (+6) No (+0) - Open or Dislocated Femur Fracture Yes (+3) No (+0) - Patient Male Yes (+1) No (+0) 8-Vandromme Score Stems from a retrospective analysis of datasets from civilian trauma patients admitted to a single level 1 trauma center in the USA. Five Variables: 1-Blood Lactate ≥ 5 mmol/L 2-Heart Rate > 105 3-INR > 1.5 4-Hemoglobin ≤ 11 g/dL 5-SBP < 110 mm Hg (Vandromme MJ et al, 2011)
Posted on: Thu, 14 Aug 2014 18:27:34 +0000
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