Pre-hospital assessment of trauma associated severe hemorrhage (phTASH) - analysis of TraumaRegister DGU

backgroundPrehospital transfusions are becoming increasingly popular in Europe. Blood products play an important role in the treatment of massive hemorrhage but may pose a potential risk to the patient when the indication is inconclusive such as in a prehospital setting. Simple scores are required in order to initiate targeted therapy and to use the valuable resource of blood comprehensibly in the prehospital setting. With the Assessment of Blood Consumption (ABC)-score and the reversed Shock Index GCS (rSIG)-score, two scores with a good predictive quality for the occurrence of massive transfusion have already been described. However, both scores were validated with in-hospital data that do not correspond to the characteristics of the European trauma population. Aim of this study is to validate both scores with data that represent the European trauma population and to discuss the usability to justify prehospital blood transfusion.

methodsUsing data from the TraumaRegister DGU

resultsWe included 63,946 datasets. 8.5% of all patients received a transfusion and 1% a mass transfusion after hospital admission. The mean Injury Severity Score (ISS) for patients with massive transfusion was 39.9 vs. 16.8 without massive transfusion. The ABC score has an AUROC of 0.711 (0.702-0.719) for any transfusion (≥ 1 packed Red Blood Cells; pRBC) and of 0.806 (0.786-0.826) for massive transfusion (≥ 10 pRBC). The rSIG score has an AUROC of 0.737 (0.730-0.744) vs. 0.807 (0.790-0.824) respectively. The phTASH score is calculated with an AUROC of 0.747 (0.737-07.53) for the prediction of any transfusion and an AUROC of 0.834 (0.816-0.952) for the prediction of massive transfusion after severe trauma. The three items with the greatest influence on the score results are the positive Focused Assessment with Sonography in Trauma (FAST) examination (OR 5.28), systolic blood pressure < 90mmHg (OR 2.94) and a shock index > 1 (OR 2.49).

conclusionsThe need for transfusion can easily be assessed even in the prehospital setting. The new developed phTASH score has a high predictive accuracy for transfusions after trauma. The identification of a positive FAST examination as the element with the greatest impact on predicting a patient's need for transfusion emphasizes the importance of prehospital ultrasound.