The Massive Transfusion Score as a decision aid for resuscitation: Learning when to turn the massive transfusion protocol on and off

Rachael A. Callcut, Michael W. Cripps, Mary F. Nelson, Amanda S. Conroy, Bryce B R Robinson, Mitchell J. Cohen

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND: Previous work proposed a Massive Transfusion Score (MTS) calculated from values obtained in the emergency department to predict likelihood of massive transfusion (MT).We hypothesized theMTS could be used at Hour 6 to differentiate who continues to require balanced resuscitation in Hours 7 to 24 and to predict death at 28 days. METHODS: We prospectively enrolled patients in whom the MT protocol was initiated from 2005 to 2011. Data including timing of blood products were determined at Hours 0, 6, 12, and 24. For each patient, transfusion needs were defined based on either an inappropriately low hemoglobin response to transfusion or a hemoglobin decrease of greater than 1 g/dL if no transfusion. Timing and cause of death were used to account for survivor bias. Multivariate logistic regression was used to determine independent predictors of outcome. RESULTS: A total of 190 MT protocol activations were included, and by Hour 6, 61% required 10 U or greater packed red blood cells. Calculated at initial presentation, a revised MTS (systolic blood pressure <90 mm Hg, base deficit ≥6, temperature <35.5°C, international normalized ratio > 1.5, hemoglobin <11 g/dL) was superior to the original MTS (including heart rate ≥120 beats per minute, Focused Assessment With Sonography in Trauma [FAST] status, mechanism) or the Assessment of Blood Consumption (ABC) score for predicting MT (area under the curve [AUC] MT at 6 hours, 0.68; 95% confidence interval [CI], 0.57.0.79; at 24 hours, 0.72; 0.61.0.83; p <0.05). For those alive atHour 6, the revisedMTSwas predictive of future packed red blood cell need (AUC, 0.87) in Hours 7 to 12, 24-hour mortality (AUC, 0.95), and 28-day mortality (AUC, 0.77). For each additional positive trigger of the MTS at Hour 6, the odds of death at 24 hours and 28 days were substantially increased (24-hour odds ratio, 4.6; 95% CI, 2.3.9.3; 28-day odds ratio, 2.2; 95% CI, 1.5.3.2; p <0.0001). CONCLUSION: Early end points of resuscitation adopted from the components of the revisedMTS are predictive of ongoing transfusion. Failure to normalize these components by Hour 6 portends a particularly poor prognosis.

Original languageEnglish (US)
Pages (from-to)450-456
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number3
DOIs
StatePublished - 2016

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Decision Support Techniques
Resuscitation
Area Under Curve
Learning
Hemoglobins
Confidence Intervals
Erythrocytes
Odds Ratio
Blood Pressure
Mortality
Survivors
Hospital Emergency Service
Cause of Death
Ultrasonography
Heart Rate
Logistic Models
Wounds and Injuries

Keywords

  • Massive transfusion protocol
  • Massive Transfusion Score (MTS)
  • Trauma transfusion triggers

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

The Massive Transfusion Score as a decision aid for resuscitation : Learning when to turn the massive transfusion protocol on and off. / Callcut, Rachael A.; Cripps, Michael W.; Nelson, Mary F.; Conroy, Amanda S.; Robinson, Bryce B R; Cohen, Mitchell J.

In: Journal of Trauma and Acute Care Surgery, Vol. 80, No. 3, 2016, p. 450-456.

Research output: Contribution to journalArticle

Callcut, Rachael A. ; Cripps, Michael W. ; Nelson, Mary F. ; Conroy, Amanda S. ; Robinson, Bryce B R ; Cohen, Mitchell J. / The Massive Transfusion Score as a decision aid for resuscitation : Learning when to turn the massive transfusion protocol on and off. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 80, No. 3. pp. 450-456.
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abstract = "BACKGROUND: Previous work proposed a Massive Transfusion Score (MTS) calculated from values obtained in the emergency department to predict likelihood of massive transfusion (MT).We hypothesized theMTS could be used at Hour 6 to differentiate who continues to require balanced resuscitation in Hours 7 to 24 and to predict death at 28 days. METHODS: We prospectively enrolled patients in whom the MT protocol was initiated from 2005 to 2011. Data including timing of blood products were determined at Hours 0, 6, 12, and 24. For each patient, transfusion needs were defined based on either an inappropriately low hemoglobin response to transfusion or a hemoglobin decrease of greater than 1 g/dL if no transfusion. Timing and cause of death were used to account for survivor bias. Multivariate logistic regression was used to determine independent predictors of outcome. RESULTS: A total of 190 MT protocol activations were included, and by Hour 6, 61{\%} required 10 U or greater packed red blood cells. Calculated at initial presentation, a revised MTS (systolic blood pressure <90 mm Hg, base deficit ≥6, temperature <35.5°C, international normalized ratio > 1.5, hemoglobin <11 g/dL) was superior to the original MTS (including heart rate ≥120 beats per minute, Focused Assessment With Sonography in Trauma [FAST] status, mechanism) or the Assessment of Blood Consumption (ABC) score for predicting MT (area under the curve [AUC] MT at 6 hours, 0.68; 95{\%} confidence interval [CI], 0.57.0.79; at 24 hours, 0.72; 0.61.0.83; p <0.05). For those alive atHour 6, the revisedMTSwas predictive of future packed red blood cell need (AUC, 0.87) in Hours 7 to 12, 24-hour mortality (AUC, 0.95), and 28-day mortality (AUC, 0.77). For each additional positive trigger of the MTS at Hour 6, the odds of death at 24 hours and 28 days were substantially increased (24-hour odds ratio, 4.6; 95{\%} CI, 2.3.9.3; 28-day odds ratio, 2.2; 95{\%} CI, 1.5.3.2; p <0.0001). CONCLUSION: Early end points of resuscitation adopted from the components of the revisedMTS are predictive of ongoing transfusion. Failure to normalize these components by Hour 6 portends a particularly poor prognosis.",
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N2 - BACKGROUND: Previous work proposed a Massive Transfusion Score (MTS) calculated from values obtained in the emergency department to predict likelihood of massive transfusion (MT).We hypothesized theMTS could be used at Hour 6 to differentiate who continues to require balanced resuscitation in Hours 7 to 24 and to predict death at 28 days. METHODS: We prospectively enrolled patients in whom the MT protocol was initiated from 2005 to 2011. Data including timing of blood products were determined at Hours 0, 6, 12, and 24. For each patient, transfusion needs were defined based on either an inappropriately low hemoglobin response to transfusion or a hemoglobin decrease of greater than 1 g/dL if no transfusion. Timing and cause of death were used to account for survivor bias. Multivariate logistic regression was used to determine independent predictors of outcome. RESULTS: A total of 190 MT protocol activations were included, and by Hour 6, 61% required 10 U or greater packed red blood cells. Calculated at initial presentation, a revised MTS (systolic blood pressure <90 mm Hg, base deficit ≥6, temperature <35.5°C, international normalized ratio > 1.5, hemoglobin <11 g/dL) was superior to the original MTS (including heart rate ≥120 beats per minute, Focused Assessment With Sonography in Trauma [FAST] status, mechanism) or the Assessment of Blood Consumption (ABC) score for predicting MT (area under the curve [AUC] MT at 6 hours, 0.68; 95% confidence interval [CI], 0.57.0.79; at 24 hours, 0.72; 0.61.0.83; p <0.05). For those alive atHour 6, the revisedMTSwas predictive of future packed red blood cell need (AUC, 0.87) in Hours 7 to 12, 24-hour mortality (AUC, 0.95), and 28-day mortality (AUC, 0.77). For each additional positive trigger of the MTS at Hour 6, the odds of death at 24 hours and 28 days were substantially increased (24-hour odds ratio, 4.6; 95% CI, 2.3.9.3; 28-day odds ratio, 2.2; 95% CI, 1.5.3.2; p <0.0001). CONCLUSION: Early end points of resuscitation adopted from the components of the revisedMTS are predictive of ongoing transfusion. Failure to normalize these components by Hour 6 portends a particularly poor prognosis.

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