Development of Prehospital Factors for Predicting Massive Blood Transfusion in Trauma Patients

Abstract

Background: Massive blood loss is the primary cause of immediate death in trauma patients. In prehospital care, where laboratory and investigation resources are limited, a massive blood transfusion (MBT) scoring system could activate blood bank preparation of blood components and facilitate EMS decision-making regarding the appropriate trauma center destination. This is particularly significant in urban environments where motor vehicle accidents are highly prevalent. Materials and Methods: A retrospective cohort study was conducted using data from prehospital trauma patients. Predictive parameters, including vital signs, mechanism of injury, and serious injury body parts, were analyzed, and the significant parameters identified by a multivariable analysis were used to develop a clinical scoring system. Discrimination was evaluated by the area under the receiver operating characteristic (AuROC) curve, calibration was demonstrated with the Hosmer-Lemeshow goodness of fit test, and internal validation was performed. Results: Among 511 trauma patients, 72 (14.1%) received MBT. The prehospital factors that significantly predicted massive MBT included hypotension with a SBP of less than 90 mmHg, penetrating object injuries, serious injuries to the face, thorax, abdomen, extremities including the pelvis, and the use of life-saving interventions such as advanced airway management and pelvic binding. The AuROC was 0.943 (95% CI 0.914 to 0.972, p<0.001). The probability of receiving massive transfusion was 94.79% in patients with score of 5 or higher. Conclusion: The prehospital MBT score demonstrates good performance and discrimination for predicting MBT using simple and rapidly obtainable parameters in a prehospital setting. Keywords: Massive transfusion; Massive bleeding; Prehospital care