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Multicenter Study
. 2013 Jan;74(1):59-65, 67-8; discussion 66-7.
doi: 10.1097/TA.0b013e3182788b34.

Defining when to initiate massive transfusion: a validation study of individual massive transfusion triggers in PROMMTT patients

Rachael A Callcut  1 , Bryan A Cotton, Peter Muskat, Erin E Fox, Charles E Wade, John B Holcomb, Martin A Schreiber, Mohammad H Rahbar, Mitchell J Cohen, M Margaret Knudson, Karen J Brasel, Eileen M Bulger, Deborah J Del Junco, John G Myers, Louis H Alarcon, Bryce R H Robinson; PROMMTT Study Group
Collaborators, Affiliations
Multicenter Study

Defining when to initiate massive transfusion: a validation study of individual massive transfusion triggers in PROMMTT patients

Rachael A Callcut et al. J Trauma Acute Care Surg. 2013 Jan.

Abstract

Background: Early predictors of massive transfusion (MT) would prevent undertriage of patients likely to require MT. This study validates triggers using the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study.

Methods: All enrolled patients in PROMMTT were analyzed. The initial emergency department value for each trigger (international normalized ratio [INR], systolic blood pressure, hemoglobin, base deficit, positive result for Focused Assessment for the Sonography of Trauma examination, heart rate, temperature, and penetrating injury mechanism) was compared for patients receiving MT (≥ 10 U of packed red blood cells in 24 hours) versus no MT. Adjusted odds ratios (ORs) for MT are reported using multiple logistic regression. If all triggers were known, a Massive Transfusion Score (MTS) was created, with 1 point assigned for each met trigger.

Results: A total of 1,245 patients were prospectively enrolled with 297 receiving an MT. Data were available for all triggers in 66% of the patients including 67% of the MTs (199 of 297). INR was known in 87% (1,081 of 1,245). All triggers except penetrating injury mechanism and heart rate were valid individual predictors of MT, with INR as the most predictive (adjusted OR, 2.5; 95% confidence interval, 1.7-3.7). For those with all triggers known, a positive INR trigger was seen in 49% receiving MT. Patients with an MTS of less than 2 were unlikely to receive MT (negative predictive value, 89%). If any two triggers were present (MTS ≥ 2), sensitivity for predicting MT was 85%. MT was present in 33% with an MTS of 2 greater compared with 11% of those with MTS of less than 2 (OR, 3.9; 95% confidence interval, 2.6-5.8; p < 0.0005).

Conclusion: Parameters that can be obtained early in the initial emergency department evaluation are valid predictors for determining the likelihood of MT.

Level of evidence: Diagnostic, level II.

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Conflict of interest statement

Conflicts of Interest:

  1. Dr. Holcomb reports serving on the board for Tenaxis, Winkenwerder Company, the Regional Advisory Council for Trauma, and the National Trauma Institute; providing expert testimony for the Department of Justice; grants funded by Haemonetics Corporation, and KCI USA, Inc. and patent royalities paid through his institution.

  2. Dr. Wade reported serving on the Science Board for Resuscitation Products, Inc and the Advisory Board for Astrazeneca.

  3. No other disclosures by other authors are reported.

Figures

FIGURE 1
FIGURE 1. Prediction of MT based upon the Massive Transfusion Score (MTS)
a: Prediction of MT using the MTS including FAST b: Prediction of MT using the Limited MTS MT: massive transfusion; MTS: massive transfusion score; MT 24 h: 10+ units RBCs in 24 hours; MT 24h+ : 10+ units RBCs in 24 hours plus hemorrhagic deaths within 24 hours; MT6h+ : 10+ units RBCs at 6 hours plus hemorrhagic deaths within 6 hours;
See this image and copyright information in PMC

References

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