5 Feb 2016

Predicting patients who require large blood transfusions

By Dr Jodie Abramovitch

Loss of large volumes of blood is responsible for a third of all deaths associated with trauma. The only way to treat a loss of blood, also known as haemorrhagic shock, is via transfusion of blood products. Some trauma patients require transfusion with incredibly large amounts of blood – a massive transfusion (MT) - and their survival may depend on the timely delivery of blood or blood products.  

Director of the National Trauma Research Institute
and senior author Professor Mark Fitzgerald
To create a robust system that allows for the prediction of patients who may require MT, researchers from Monash University and the Alfred Hospital (Trauma Centre, National Trauma Research Institute, Department of Epidemiology and Preventive Medicine and Ambulance Victoria) explored whether use of a ‘shock index’ (SI) calculated before and after arrival at hospital could predict MT. SI is calculated simply by measuring heart rate and dividing it by measured systolic blood pressure.

Of the 6990 major trauma patients who presented at the Alfred Hospital between 2006 - 2012, 5.2% (360 patients) received MT. By using a number of statistical models it was shown that a SI calculated before arrival at hospital was able to significantly improve prediction of MT. Combining the SIs calculated before and after arrival at hospital was only slightly better at predicting MT than the SI measured after arrival at hospital alone.

Considering these observations it was concluded that the SI is a simple option to assist with the prediction of MT. However further study is warranted to validate the SI prospectively. The development and implementation of computer-assisted data collection and prognostication may further enhance the utility of the SI in predicting MT.

Reference: Olaussen APeterson ELMitra BO'Reilly GJennings PAFitzgerald MMassive transfusion prediction with inclusion of the pre-hospital Shock Index. Injury  2015 May: 46;822-6. 
doi: 10.1016/j.injury.2014.12.009

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