Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;21(2):96-99.
doi: 10.1016/j.cjtee.2017.12.003. Epub 2018 Mar 3.

Combination of blood lactate level with assessment of blood consumption (ABC) scoring system: A more accurate predictor of massive transfusion requirement

Wongsakorn Chaochankit  1 , Osaree Akaraborworn  2 , Burapat Sangthong  2 , Komet Thongkhao  2
Affiliations

Combination of blood lactate level with assessment of blood consumption (ABC) scoring system: A more accurate predictor of massive transfusion requirement

Wongsakorn Chaochankit et al. Chin J Traumatol. 2018 Apr.

Abstract

Purpose: Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion (MT) protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption (ABC) score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MT.

Methods: The data were retrospectively collected from 165 trauma patients following the trauma activated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score ≥2 as the cut point for MT were defined as the ABC group. All patients who had a score ≥2 with a lactate level >4 mmol/dL were defined as the ABC plus lactate level (ABC + L) group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC + L groups. The ability of ABC and ABC + L groups to predict MT was estimated by the area under the receiver operating characteristic curve (AUROC).

Results: Among 165 patients, 15 patients (9%) required massive blood transfusion. There were no significant differences in age, gender, mechanism of injury or initial vital signs between the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low (81%, 34%, AUC 0.573). The sensitivity and specificity were significantly better in the ABC + L group (92%, 42%, AUC = 0.745).

Conclusion: The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.

Keywords: Assessment of blood consumption scoring system; Blood lactate level; Massive transfusion.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow of patients.
Fig. 2
Fig. 2
The area under the curve (AUC) between ABC scoring system with blood lactate level and ABC scoring system alone (N = 165).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. McLeod J.B., Lynn M., Mckenney M.G. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44. - PubMed
    1. Sauaia A., Moore F.A. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185–193. - PubMed
    1. Kauvar D.S., Lefering R., Wade C.E. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60:S3–S11. - PubMed
    1. Cap A., Hunt B. Acute traumatic coagulopathy. Curr Opin Crit Care. 2014;20:638–645. - PubMed
    1. Martinowitz U.M.M. Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rVIIa task force. J Thromb Haemost. 2005;3:640–648. - PubMed