Combination of blood lactate level with assessment of blood consumption （ABC） scoring system： A more accurate predictor of massive transfusion requirement

Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption （ABC） score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MTo Methods： The data were retrospectively collected from 165 trauma patients following the trauma acti- vated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score 〉2 as the cut point for MT were defined as the ABC group. All patients who had a score 〉2 with a lactate level 〉4 mmol/dL were defined as the ABC plus lactate level （ABC ＋ L） group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC ＋ L groups. The ability of ABC and ABC ＋ L groups to predict MT was estimated by the area under the receiver operating characteristic curve （AUROC）. Results： Among 165 patients, 15 patients （9%） required massive blood transfusion. There were no sig- nificant differences in age, gender, mechanism of injury or initial vital signs bet^teen the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low （81%, 34%, AUC 0.573）. The sensitivity and specificity were significantly better in the ABC ＋ L group （92%, 42%, AUC = 0.745）. Conclusion： The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.

Evaluation of massive transfusion protocol practices by type of trauma at a level I trauma center

Purpose： To evaluate massive transfusion protocol practices by trauma type at a level I trauma center. Methods： A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained. Results： Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score （ISS）, higher probability of survival （POS）, decreased mortality, and higher Glasgow Coma scale （GCS） compared to blunt trauma patients. Overall, the mortality rate was 38.16~. The most common injury sustained among blunt trauma patients was head injury （36.21~）, whereas the majority of the penetrating trauma patients sustained abdominal injuries （55.56~）. Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients （p 〈 0.01 ）. Conclusion： Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients.

Enhancing the clinical relevance of haemorrhage prediction models in trauma

We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of traumatic haemorrhage.We thank the authors for their contribution to the role of ML in trauma.