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Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry

Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with...

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Autores principales: Cornero, Sara Giulia, Maegele, Marc, Lefering, Rolf, Abbati, Claudia, Gupta, Shailvi, Sammartano, Fabrizio, Cimbanassi, Stefania, Chiara, Osvaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601146/
https://www.ncbi.nlm.nih.gov/pubmed/33050378
http://dx.doi.org/10.3390/jcm9103235
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author Cornero, Sara Giulia
Maegele, Marc
Lefering, Rolf
Abbati, Claudia
Gupta, Shailvi
Sammartano, Fabrizio
Cimbanassi, Stefania
Chiara, Osvaldo
author_facet Cornero, Sara Giulia
Maegele, Marc
Lefering, Rolf
Abbati, Claudia
Gupta, Shailvi
Sammartano, Fabrizio
Cimbanassi, Stefania
Chiara, Osvaldo
author_sort Cornero, Sara Giulia
collection PubMed
description Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT−). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage.
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spelling pubmed-76011462020-11-01 Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry Cornero, Sara Giulia Maegele, Marc Lefering, Rolf Abbati, Claudia Gupta, Shailvi Sammartano, Fabrizio Cimbanassi, Stefania Chiara, Osvaldo J Clin Med Article Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT−). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage. MDPI 2020-10-10 /pmc/articles/PMC7601146/ /pubmed/33050378 http://dx.doi.org/10.3390/jcm9103235 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cornero, Sara Giulia
Maegele, Marc
Lefering, Rolf
Abbati, Claudia
Gupta, Shailvi
Sammartano, Fabrizio
Cimbanassi, Stefania
Chiara, Osvaldo
Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry
title Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry
title_full Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry
title_fullStr Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry
title_full_unstemmed Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry
title_short Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry
title_sort predictive factors for massive transfusion in trauma: a novel clinical score from an italian trauma center and german trauma registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601146/
https://www.ncbi.nlm.nih.gov/pubmed/33050378
http://dx.doi.org/10.3390/jcm9103235
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