Predictors of massive transfusion protocols activation in patients with trauma in Korea: a systematic review.

Journal of Trauma and Injury Pub Date : 2024-06-01 Epub Date: 2024-06-14 DOI:10.20408/jti.2024.0015
Dongmin Seo, Inhae Heo, Juhong Park, Junsik Kwon, Hye-Min Sohn, Kyoungwon Jung
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Abstract

Purpose: Massive transfusion protocols (MTPs) implementation improves clinical outcomes of the patient's resuscitation with hemorrhagic trauma. Various predictive scoring system have been used and studied worldwide to improve clinical decision. However, such research has not yet been studied in Korea. This systematic review aimed to assess the predictors of MTPs activation in patients with trauma in Korea.

Methods: The PubMed, Embase, Cochrane Library, Research Information Sharing Service databases, KoreaMed, and KMbase were searched from November 2022. All studies conducted in Korea that utilized predictors of MTPs activation in adult patients with trauma were included.

Results: Ten articles were eligible for analysis, and the predictors were assessed. Clinical assessments such as systolic and diastolic blood pressure, shock index (SI), prehospital modified SI, modified early warning system (MEWS) and reverse SI multiplied by the Glasgow Coma Scale (rSIG) were used. Laboratory values such as lactate level, fibrinogen degradation product/fibrinogen ratio, and rotational thromboelastometry (ROTEM) were used. Imaging examinations such as pelvic bleeding score were used as predictors of MTPs activation.

Conclusions: Our systematic review identified predictors of MTPs activation in patients with trauma in Korea; predictions were performed using tools that requires clinical assessments, laboratory values or imaging examinations only. Among them, ROTEM, rSIG, MEWS, SI, and lactate level showed good effects for predictions of MTPs activation. The application of predictors for MTP's activation should be individualized based on hospital resource and skill set, also should be performed as a clinical decision supporting tools.

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韩国外伤患者启动大量输血方案的预测因素:系统综述。
目的:实施大规模输血方案(MTPs)可改善出血性创伤患者复苏的临床效果。世界各地都在使用和研究各种预测评分系统,以改进临床决策。然而,韩国尚未开展此类研究。本系统综述旨在评估韩国创伤患者 MTPs 激活的预测因素:方法:自 2022 年 11 月起,对 PubMed、Embase、Cochrane Library、研究信息共享服务数据库、KoreaMed 和 KMbase 进行了检索。结果:有10篇文章符合分析条件,其中有3篇文章预测了成年创伤患者的MTPs激活:结果:10 篇文章符合分析条件,并对预测因素进行了评估。临床评估包括收缩压和舒张压、休克指数(SI)、院前修正 SI、修正预警系统(MEWS)和反向 SI 乘以格拉斯哥昏迷量表(rSIG)。实验室数值包括乳酸水平、纤维蛋白原降解产物/纤维蛋白原比率和旋转血栓弹性测定法(ROTEM)。盆腔出血评分等影像学检查被用作 MTPs 激活的预测指标:我们的系统综述确定了韩国外伤患者 MTPs 激活的预测指标;这些预测指标仅使用需要临床评估、实验室值或影像学检查的工具。其中,ROTEM、rSIG、MEWS、SI和乳酸水平对预测MTPs激活有良好效果。MTP激活预测指标的应用应根据医院的资源和技能进行个性化设计,同时也应作为临床决策支持工具。
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58
审稿时长
11 weeks
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