D. Burneikas2, E. E. Moore1,2, M. P. Chapman2,3, H. B. Moore1,2, E. Gonzalez1,2, C. Silliman2,4, A. Banerjee2 1Denver Health Medical Center,Aurora, CO, USA 2University Of Colorado Denver,Aurora, CO, USA 3Georgia Health Sciences University,Augusta, GA, USA 4Children’s Hospital Colorado,Aurora, CO, USA
Introduction: Massive blood transfusion is required in roughly 3% of civilian and 8% of military trauma patients and requires mobilization of enormous hospital and personnel resources to administer. Thus, accurate prediction of the need for massive transfusion in severely injured trauma patients is highly desireable from both a logistical and patient outcome standpoint. To this end, numerous trauma scoring systems have been developed to predict massive transfusion, such as the Trauma-Associated Severe Hemorrhage (TASH) and Assesment of Blood Consumption (ABC) score. These scores are cumbersome to calculate in the chaotic setting of an emergent trauma, therefore we sought to determine if admission assessment of the patient's Rapid thrombelastogram (Rapid TEG) could provide an easier and more reliable predictive parameter for massive hemorrhage and transfusion.
Methods: 61 consectutive trauma patients of our highest level of activation and deemed likely to require a massive transfusion by the attending surgeon received an admission Rapid TEG. Their ABC and TASH scores were calculated, as well as binary criteria based on the Resusciatation Outcomes Consortium vital sign inclusion criteria and our center's newly implemented MTP entrance trigger criteria. Reciever operating characteristic (ROC) plots were constructed for these scoring systems with respect to massive hemorrhage (defined as 10 or more units of PRBCS in the first 6 hours or death from massive hemorrhage prior to that time) as the binary outcome variable. ROC plots were also constructed for the Rapid TEG parameters: ACT, Alpha Angle, MA and LY30. Lastly, an ROC curve for Global TEG Assessment parameter was constructed based upon an abnormal finding in any of the three most specific TEG parameters for predicting massive hemorrhage (Alpha Angle, MA and LY30) in order to reflect the TEG tracing as a whole. The merits of these various predictive methodologies were compared according the area under their respective ROC curves.
Results: The area under the ROC curves for the scoring systems was generally very poor (ABC 0.50, TASH: 0.58) and the vital sign and MTP criteria no better (0.53). The TEG parameters generally performed better as predictors of massive hemorrhage based upon the are under their ROC curves (ACT: 0.63, Angle: 0.68 MA: 0.72, LY30: 0.71), skewed toward higher specificity. TH=he composite Global TEG parameter based on Angle, MA and LY30 improved sensitivity markedly and brought the overal area under the curve to 0.74
Conclusion: Admission Rapid TEG is a superior predictor of massive transfusion requirement to existing trauma scoring systems. It is particularly effective when teh TEG tracing is examined as a whole, rather than relying on any one parameter.
