A simple assessment of haemothoraces thickness predicts abundant transfusion: A series of 525 blunt trauma patients. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Gignon, Lucile; Charbit, Jonathan; Maury, Camille; Latry, Pascal; Taourel, Patrice; Millet, Ingrid; Capdevila, Xavier
• Is Part Of: Injury. Volume 46:Issue 1(2015)
• Page Start: 54
• Page End: 60
• Publication Date: 2015-01
• Subjects: Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2014.08.040
• Languages: English
• ISSNs: 0020-1383

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">The goal of this study was to evaluate the performance of haemothorax quantification to predict an abundant transfusion in blunt thoracic trauma patients.</p> </sec> <sec> <title id="sect0015">Methods</title> <p id="spar0010">This study included all severe trauma patients admitted into our trauma centre from January 2005 to January 2010, who presented a blunt thoracic trauma (thoracic AIS ≥1) and had a CT scan within the first hour following admission. For each haemothorax, thickness of dominant side and the cumulated thicknesses of both sides (Dominant-<italic>t</italic>, Cumulated-<italic>t</italic>), as well as lengths (Dominant-<italic>l</italic>, Cumulated-<italic>l</italic>) and the calculated volumes (Dominant-<italic>v</italic>, Cumulated-<italic>v</italic> provided by a previously validated formula) were retrospectively measured by CT scan. A multiple logistic regression was performed to define the independent risk factors for an abundant transfusion (≥5 packed red blood cells in the first 24 h). Finally, ROC curves have been drawn on an isolated thoracic trauma subgroup to predict abundant transfusion. The more specific cut-offs were extracted from this analysis.</p> </sec> <sec> <title id="sect0020">Results</title> <p id="spar0015">From the 525 blunt thoracic trauma patients (75% males, mean age 38.2 (SD18.7) years, mean ISS 22.5 (SD16.4)), 31% received an abundant transfusion. In multivariable analysis, Cumulated-<italic>t</italic> was significantly associated with an abundant transfusion (OR 1.3 [95% CI 1.1–1.4], <italic>P</italic> = 0.002). In isolated thoracic trauma subgroup (<italic>n</italic> = 251), the global abilities of different CT measurements to predict abundant transfusion were significantly comparable (AUCs 0.69–0.70). The more specific cut-offs were established at 28 mm for Cumulated-<italic>t</italic> (specificity 92%, positive predictive value 47%) and at 24 mm for Dominant-<italic>t</italic> (specificity 92%; positive predictive value 43%).</p> </sec> <sec> <title id="sect0025">Conclusion</title> <p id="spar0020">The haemothorax quantification upon admission may help to predict transfusion needs. Cumulated-<italic>t</italic> was found independent risk factor for abundant transfusion in a large population of severe trauma patients. Beyond a Cumulated-<italic>t</italic> of 28 mm or a Dominant-<italic>t</italic> of 24 mm, abundant transfusion will be very frequently necessary.</p> </sec> <sec> <title id="sect0030">Level of evidence</title> <p id="spar0025">Retrospective review, level III.</p> </sec> </abstract>