Defining when to initiate massive transfusion: A validation study of individual massive transfusion triggers in PROMMTT patients
Defining when to initiate massive transfusion: A validation study of individual massive transfusion triggers in PROMMTT patients
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DOI：
10.1097/ta.0b013e3182788b34
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发表时间：
2013-01-01
影响因子：
3.4
通讯作者：
Robinson, Bryce R. H.
中科院分区：
文献类型：
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作者：
Callcut, Rachael A.;Cotton, Bryan A.;Robinson, Bryce R. H.
背景：大量输血 (MT) 的早期预测因素将防止可能需要 MT 的患者分类不足。本研究使用前瞻性观察性多中心重大创伤输血 (PROMMTT) 研究验证触发因素。方法：对所有纳入 PROMMTT 的患者进行分析。将接受 MT（24 小时内>= 10 U 浓缩红细胞）的患者与未接受 MT 的患者的每个触发因素（国际标准化比值 [INR]、收缩压、血红蛋白、基础赤字、创伤超声检查重点评估阳性结果、心率、体温和穿透性损伤机制）的初始急诊科值进行比较。使用多元逻辑回归报告 MT 的调整后优势比 (OR)。如果已知所有触发因素，则创建大规模输血评分 (MTS)，每个满足触发因素分配 1 分。 结果：总共 1,245 名患者前瞻性入组，其中 297 名接受 MT。 66% 的患者（包括 67% 的 MT）（297 例中的 199 例）的所有触发因素的数据均可用。 87% 的人知道 INR（1,245 人中的 1,081 人）。除穿透性损伤机制和心率外，所有触发因素都是 MT 的有效个体预测因子，其中 INR 最具预测性（调整后 OR，2.5；95% 置信区间，1.7-3.7）。对于那些已知所有触发因素的人来说，接受 MT 的 49% 的人发现 INR 呈阳性触发。 MTS 小于 2 的患者不太可能接受 MT（阴性预测值，89%）。如果存在任意两个触发因素 (MTS >= 2)，则预测 MT 的敏感性为 85%。 MTS 大于 2 的患者中有 33% 存在 MT，而 MTS 小于 2 的患者中有 11% 存在 MT（OR，3.9；95% 置信区间，2.6-5.8；p < 0.0005）。结论：在初始急诊科评估中早期获得的参数是确定 MT 可能性的有效预测因子。 （J Trauma Acute Care Surg. 2013；74：59-68。版权所有 (C) 2013，Lippincott Williams & Wilkins）
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. (J Trauma Acute Care Surg. 2013; 74: 59-68. Copyright (C) 2013 by Lippincott Williams & Wilkins)