A simple predictive formula for the blood requirement in patients with high‐energy blunt injuries transferred within one hour post‐trauma. Issue 2 (20th October 2014)

• Record Type: Journal Article
• Authors: Akasaki, Yukio; Sugimori, Hiroshi; Momii, Kenta; Akahoshi, Tomohiko; Matsuura, Suguru; Iwamoto, Yukihide; Maehara, Yoshihiko; Hashizume, Makoto
• Is Part Of: Acute medicine & surgery. Volume 2:Issue 2 (2015)
• Page Start: 82
• Page End: 91
• Publication Date: 2014-10-20
• Subjects: Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.74
• Languages: English
• ISSNs: 2052-8817

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ams274-sec-0001" sec-type="section"> <title>Aims</title> <p>To recognize patients who require massive transfusion at the early stage of blunt trauma, we retrospectively investigated patients with high‐energy blunt injuries transferred within 1 h post‐trauma.</p> </sec> <sec id="ams274-sec-0002" sec-type="section"> <title>Methods</title> <p>Between August 2007 and July 2011, 233 trauma patients were: (i) injured by a high‐energy blunt mechanism with Injury Severity Score ≥9; (ii) not dead on arrival; (iii) older than 9 years; and (iv) at our center within 1 h after injury. The findings for 113 of those patients were analyzed, including those produced by ultrasonography, computed tomography, and arterial blood gas analyses.</p> </sec> <sec id="ams274-sec-0003" sec-type="section"> <title>Results</title> <p>Of 113 patients, 33 underwent massive transfusion (≥6 units) within 8 h of arrival. A logistic regression analysis revealed that an arterial lactate level ≥28 mg/dL (<italic>P</italic> < 0.001; odds ratio, 105.11; 95% confidence interval, 12.58–2, 718.84) and a flat ratio of the inferior vena cava on computed tomography ≥3 (<italic>P</italic> < 0.001; odds ratio, 32.50; 95% confidence interval, 4.44–714.44) were significant independent predictors for a massive transfusion within 8 h. In a receiver operating curve analysis, the area under the curve of the need for massive transfusion was 0.956, with a sensitivity of 0.94 and a specificity of 0.90. A linear predictive formula for the probability (P) of receiving a massive transfusion was generated as P = 2 × lactate (mg/dL) + 15 × the flat ratio of inferior vena cava − 103. Using another 52 trauma patients, the formula was validated.</p> </sec> <sec id="ams274-sec-0004" sec-type="section"> <title>Conclusions</title> <p>An elevated level of arterial lactate and the flat ratio of inferior vena cava were significant predictors for identifying the patients who would require a massive transfusion in the early stage after high‐energy blunt trauma.</p> </sec> </abstract>