Development of prehospital assessment findings associated with massive transfusion

• Published in: Transfusion (Philadelphia, Pa.) Vol. 60; no. S3; pp. S70 - S76
• Main Authors: Wheeler, Abigail R., Cuenca, Camaren, Fisher, Andrew D., April, Michael D., Shackelford, Stacy A., Schauer, Steven G.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-06-2020; Wiley Subscription Services, Inc
• Subjects: Blood; Cardiac arrhythmia; Casualties; Datasets; Injuries; Injury analysis; Prediction models; Resuscitation; Scale models; Secondary analysis; Tachycardia; Transfusion; Trauma
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.15595

BACKGROUND
Massive transfusion is frequently a component of the resuscitation of combat casualties. Because blood supplies may be limited, activation of a walking blood bank and mobilization of necessary resources must occur in a timely fashion. The development of a risk prediction model to guide clinicians for early transfusion in the prehospital setting was sought.
STUDY DESIGN AND METHODS
This is a secondary analysis of a previously described data set from the Department of Defense Trauma Registry from January 2007 to August 2016 focusing on casualties undergoing massive transfusion. Serious injury was defined based on an Abbreviated Injury Scale score of 3 or greater by body region. The authors constructed multiple imputations of the model for risk prediction development. Efforts were made to internally validate the model.
RESULTS
Within the data set, there were 15540 patients, of which 1238 (7.9%) underwent massive transfusion. In the body region injury scale model, explosive injuries (odds ratio [OR], 3.78), serious extremity injuries (OR, 6.59), and tachycardia >120/min (OR, 5.61) were most strongly associated with receiving a massive transfusion. In the simplified model, major amputations (OR, 17.02), tourniquet application (OR, 6.66), and tachycardia >120 beats/min (OR, 8.72) were associated with massive transfusion. Both models had area under the curve receiver operating characteristic values of greater than 0.9 for the model and bootstrap forest analysis.
CONCLUSION
In the body region injury scale model, explosive mechanisms, serious extremity injuries, and tachycardia were most strongly associated with massive transfusion. In the simplified model, major amputations, tourniquet application, and tachycardia were most strongly associated.