Original Scientific Report

Massive Transfusion: The Revised Assessment of Bleeding and Transfusion (RABT) Score

Corresponding Author

Bellal Joseph

[email protected]
520-626-5056

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

Tel.: 520-626-5056, [email protected]Search for more papers by this author

Muhammad Khan,

Muhammad Khan

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Michael Truitt,

Michael Truitt

Division of Trauma and Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA

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Faisal Jehan,

Faisal Jehan

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Narong Kulvatunyou,

Narong Kulvatunyou

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Asad Azim,

Asad Azim

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Arpana Jain,

Arpana Jain

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Muhammad Zeeshan,

Muhammad Zeeshan

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Andrew Tang,

Andrew Tang

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Terence O’Keeffe,

Terence O’Keeffe

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Bellal Joseph,

Corresponding Author

Bellal Joseph

[email protected]
520-626-5056

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

Tel.: 520-626-5056, [email protected]Search for more papers by this author

Muhammad Khan,

Muhammad Khan

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

Search for more papers by this author

Michael Truitt,

Michael Truitt

Division of Trauma and Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA

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Faisal Jehan,

Faisal Jehan

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

Search for more papers by this author

Narong Kulvatunyou,

Narong Kulvatunyou

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

Search for more papers by this author

Asad Azim,

Asad Azim

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Arpana Jain,

Arpana Jain

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Muhammad Zeeshan,

Muhammad Zeeshan

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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Andrew Tang,

Andrew Tang

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

Search for more papers by this author

Terence O’Keeffe,

Terence O’Keeffe

Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, 85724 Tucson, AZ, USA

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First published: 21 May 2018

https://doi.org/10.1007/s00268-018-4674-y

Citations: 32

Oral presentation at the 47th Word Surgical Congress of Surgery, 13th–17th August 2017, Basel, Switzerland.

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Abstract

Background

Massive transfusion (MT) is a lifesaving treatment for trauma patients with hemorrhagic shock, assessed by Assessment of Blood Consumption (ABC) Score based on mechanism of injury, systolic blood pressure (SBP), tachycardia, and FAST exam. The aim of this study was to assess the performance of ABC score by replacing hypotension and tachycardia; with Shock Index (SI) > 1.0 and including pelvic fractures.

Methods

We performed a 2-year (2014–2015) analysis of all high-level trauma activations and excluded patients dead on arrival. The ABC score was calculated using the 4-point score [blunt (0)/penetrating trauma (1), HR ≥ 120 (1), SBP ≤ 90 mmHg (1), and FAST positive (1)]. The Revised Assessment of Bleeding and Transfusion (RABT) score also included 4 points, calculated by replacing HR and SBP with SI > 1.0 and including pelvic fracture. AUROC compared performances of the two scores.

Results

A total of 380 patients were included. The overall MT was 27%. Patients receiving MT had higher median ABC scores [1.1 (0–2) vs. 1 (0–2), p = 0.15] and RABT scores [2 (1–3) vs. 1 (0–2), p < 0.001]. The RABT score had better discriminative power (AUROC = 0.828) compared to ABC score (AUROC = 0.617) for predicting the need for MT. Cutoff of RABT score ≥ 2 had a sensitivity of 84% and specificity of 77% for predicting need for MT compared to ABC score with 39% sensitivity and 72% specificity.

Conclusion

Replacement of hypotension and tachycardia with a SI > 1.0 and inclusion of pelvic fracture enhanced discrimination of ABC score for predicting the need for MT. The current ABC score would benefit from revision to more appropriately identify patients requiring MT.

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Volume42, Issue11

November 2018

Pages 3560-3567

Massive Transfusion: The Revised Assessment of Bleeding and Transfusion (RABT) Score

Abstract

Background

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Results

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References

Citing Literature

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Massive Transfusion: The Revised Assessment of Bleeding and Transfusion (RABT) Score

Abstract

Background

Methods

Results

Conclusion

References

Citing Literature

References

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