Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma: Retrospective analysis of a large regional trauma database.
Details
Serval ID
serval:BIB_A12CFC8A32BF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma: Retrospective analysis of a large regional trauma database.
Journal
The journal of trauma and acute care surgery
ISSN
2163-0763 (Electronic)
ISSN-L
2163-0755
Publication state
Published
Issued date
10/2016
Peer-reviewed
Oui
Volume
81
Number
4
Pages
713-722
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
Early and accurate detection of severe hemorrhage is critical for a timely trigger of massive transfusion (MT). Hemodynamic indices combining heart rate (HR) and either systolic (shock index [SI]) or pulse pressure (PP) (PP/HR ratio) have been shown to track blood loss during hemorrhage. The present study assessed the accuracy of prehospital SI and PP/HR ratio to predict subsequent MT, using the gray-zone approach.
This was a retrospective analysis (January 1, 2009, to December 31, 2011) of a prospectively developed trauma registry (TRENAU), in which the triage scheme combines patient severity and hospital facilities. Thresholds for MT were defined as either classic (≥10 red blood cell units within the first 24 hours [MT1]) or critical (≥3 red blood cells within the first hour [MT2]). The receiver operating characteristic curves and gray zones were defined for SI and PP/HR ratio to predict MT1 and MT2 and faced with initial triage scheme.
The TRENAU registry included 3,689 trauma patients, of which 2,557 had complete chart recovery and 176 (6.9%) required MT. In the whole population, PP/HR ratio and SI moderately and similarly predicted MT1 (area under the receiver operating characteristic curve, 0.77 [95% confidence interval {CI}, 0.70-0.84] and 0.80 [95% CI, 0.74-0.87], respectively, p = 0.064) and MT2 (0.71 [95% CI, 0.67-0.76] and 0.72 [95% CI, 0.68-0.77], respectively, p = 0.48). The proportions of patients in the gray zone for PP/HR ratio and SI were 61% versus 40%, respectively, to predict MT1 (p < 0.001) and 62% versus 71%, respectively, to predict MT2 (p < 0.001). In the least severe patient, both indices had fair accuracy to predict MT1 (0.91 [95% CI, 0.82-1.00] vs. 0.87 [95% CI, 0.79-1.00]; p = 0.638), and PP/HR ratio outperformed SI to predict MT2 (0.72 [95% CI, 0.59-0.84] vs. 0.54 [95% CI, 0.33-0.74]; p < 0.015).
In an unselected trauma population, prehospital SI and PP/HR ratio were moderately accurate in predicting MT. In the seemingly least severe patients, an improvement of prehospital undertriage for MT may be gained by using the PP/HR ratio.
Epidemiolgic study, level III.
This was a retrospective analysis (January 1, 2009, to December 31, 2011) of a prospectively developed trauma registry (TRENAU), in which the triage scheme combines patient severity and hospital facilities. Thresholds for MT were defined as either classic (≥10 red blood cell units within the first 24 hours [MT1]) or critical (≥3 red blood cells within the first hour [MT2]). The receiver operating characteristic curves and gray zones were defined for SI and PP/HR ratio to predict MT1 and MT2 and faced with initial triage scheme.
The TRENAU registry included 3,689 trauma patients, of which 2,557 had complete chart recovery and 176 (6.9%) required MT. In the whole population, PP/HR ratio and SI moderately and similarly predicted MT1 (area under the receiver operating characteristic curve, 0.77 [95% confidence interval {CI}, 0.70-0.84] and 0.80 [95% CI, 0.74-0.87], respectively, p = 0.064) and MT2 (0.71 [95% CI, 0.67-0.76] and 0.72 [95% CI, 0.68-0.77], respectively, p = 0.48). The proportions of patients in the gray zone for PP/HR ratio and SI were 61% versus 40%, respectively, to predict MT1 (p < 0.001) and 62% versus 71%, respectively, to predict MT2 (p < 0.001). In the least severe patient, both indices had fair accuracy to predict MT1 (0.91 [95% CI, 0.82-1.00] vs. 0.87 [95% CI, 0.79-1.00]; p = 0.638), and PP/HR ratio outperformed SI to predict MT2 (0.72 [95% CI, 0.59-0.84] vs. 0.54 [95% CI, 0.33-0.74]; p < 0.015).
In an unselected trauma population, prehospital SI and PP/HR ratio were moderately accurate in predicting MT. In the seemingly least severe patients, an improvement of prehospital undertriage for MT may be gained by using the PP/HR ratio.
Epidemiolgic study, level III.
Keywords
Adult, Blood Pressure/physiology, Blood Transfusion/statistics & numerical data, Emergency Medical Services, Female, Heart Rate/physiology, Hemodynamics, Humans, Injury Severity Score, Male, Predictive Value of Tests, Registries, Retrospective Studies, Shock, Hemorrhagic/physiopathology, Shock, Hemorrhagic/therapy
Pubmed
Web of science
Create date
09/03/2021 12:07
Last modification date
02/03/2022 7:35