Abstract 344: Massive Transfusion Prediction Scores Can Also Predict Early Traumatic Coagulopathy
BACK GROUND: The aggressive administration of plasma has been recommended for the improvement of traumatic coagulopathy. The survival benefit has been found in trauma resuscitation with rich plasma, and this benefit seems to be related to early use of this blood product. However, to our knowledge, no method for the recognition or prediction of traumatic cougulopathy at the point of a patient’s arrival has been established. The aim of this study was to test the predictive value of massive transfusion prediction scores for early traumatic coagulopathy.
METHOD: We reviewed records of severe trauma patients admitted to our center from Jan. 2008 to Mar. 2014, whose Injury Severity Score was 16 or more. Traumatic Bleeding Severity Score (TBSS), Trauma Associated Severe Hemorrhage Score (TASH Score), and Assessment of Blood Consumption Score (ABC Score) were calculated. Early traumatic coagulopathy was defined as 150mg/dl or less of fibrinogen and 1.5 or more of PT-INR within 6 hours from injury, although transfusion and crystalloid infusion was provider dependent. Cardiopulmonary arrest patients on arrival and simple head or spine trauma patients were excluded. Each predictive value for early traumatic coagilopathy was tested by area under the receiver operating characteristic curve (AUC). Receiver operating characteristic curve comparison was performed to compare the accuracy between TBSS, TASH Score, and ABC Score. Each spearman’s rank correlation coefficient for the amount of fresh frozen plasma transfused within 24 hours form injury was checked.
RESULT: 388 patients were enrolled in this study. The AUC of TBSS (0.927) was significantly higher than that of TASH Score (0.856) or ABC Score (0.726) (both Bonferoni adjusted p<0.01). Each Spearman’s rank correlation coefficient for the amount of fresh frozen plasma was 0.732 (TBSS, p<0.01), 0.658 (TASH Score, p<0.01), and 0.471 (ABC Score, p<0.01).
Conclusion: Massive transfusion prediction scores can also predict the early traumatic coagulopathy. TBSS had the highest predictive value and strong correlation between the score and the needed plasma. The calculation of TBSS is simple. Therefore, TBSS will rapidly predict the need for rich plasma transfusion.
Author Disclosures: T. Ogura: None. M. Nakano: None. M. Nakamura: None. K. Fujizuka: None.
- © 2014 by American Heart Association, Inc.