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. 2020 Oct 10;9(10):3235.
doi: 10.3390/jcm9103235.

Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry

Sara Giulia Cornero  1 , Marc Maegele  2 , Rolf Lefering  2 , Claudia Abbati  1 , Shailvi Gupta  3 , Fabrizio Sammartano  1 , Stefania Cimbanassi  1 , Osvaldo Chiara  1
Affiliations

Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry

Sara Giulia Cornero et al. J Clin Med. .

Abstract

Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT-). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage.

Keywords: bleeding; blood transfusion; score; trauma.

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Conflict of interest statement

The authors declare no conflict of interest. The authors declare that there are not conflict of interests or competing interests with the topics treated in the study; No public or private funding was used for the realization of this study; All original data are available in the trauma registry of ASST Niguarda.

Figures

Figure 1
Figure 1
Cohort characteristics and process of validation of the Milano score. The figure describes the steps followed to obtain the validated Milano score. ED: emergency department; MT: massive transfusion; SCI: spinal cord injury; TBI: traumatic brain injury.
Figure 2
Figure 2
Variables considered in a multivariate analysis to elaborate the predictive score for MT. Figure 2 describes the ten variables used to elaborate the predictive score for MT, their ROC curves in the study populations, and the probability of MT of the validated “Milano score”. Particularly, Figure 2A lists the variables selected on a multivariate analysis tested on german population, identifying a score with AUC of 0.738. Figure 2B represents the validated score (Milano score), applied on Milano population, with an AUC of 0.854. The probability of MT according with different score values is depicted in the histogram. (A) Application of the predictive score of MT on the trauma population selected from DGU; (B) The predictive score of MT applicated on the Italian population.
See this image and copyright information in PMC

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