Compare The Value Of Four Scoring System Predicting For Early Massive Blood Transfusion

Objective: To detect the contents of massive transfusion (MT) at a very early stageafter trauma patients.To evaluate the values of scoring system to predict the risk formassive transfusion of trauma patientas.Methods:(1)Object of study:A retrospective review of trauma patients entered intothe Emergency Room of university hospital between February2012and February2014was conducted.The criteria of enrollment included:①patient age≥16;②ISS (injuryseverity score）≥16. The exclusion criteria was the following:①died when arrival ourhospital;②burn patients;③received transfusion before arrival our hospital>1000ml;④Mainly in patients with traumatic brain injury;⑤due to missing data.(2)Group ofpatients:According to patients transfusion of20units or more of packed red blood cells(PRBC) in the first24hours after admission, patients were divided into MT group and NoMT groups.(3)Massive transfusion prediction scores:To calculate rate of massivetransfusion by TASH score,PWH score, Vandromme score,ABC score. The value of fourscore system were evaluated using receiver operating characteristic curves (ROC).Commonly used thresholds for each score were used to calculate sensitivity, specificityand the percentage of patients correctly classified.Results:Total of324patients was enrolled in the study（96.7%patients had sustainedblunt trauma），of which53patients received a massive transfusion(MT).Patients with MThad higher mortality(9.2%vs26.4%,P<0.005),ang an increased Injure Severity Score(22vs34，P<0.005). Massive transfusion at a early stage after trauma is positively related tothe value of TASH score,PWH score, Vandromme score,ABC score. Commonly usedthresholds for each score has low sensitivity（28.30%、37.73%、39.62%、43.39%）, highspecificity（98.89%、96.67%、95.20%、94.09%）,and high the percentage of patientscorrectly classified（87.34%、87.03%、86.11%、85.80%）. The depicts the AUC for all fourscores in this study. The TASH score had the highest overall accuracy as reflected by an AUC of0.892, followed by the PWH score (0.879) and the score developed byVandromme (0.845), The ABC score performed less accurately than all other scores asreflected by an AUC of0.775. These results mirror the results from the AUC calculationsin that the TASH score, was generally statistically superior, followed by the PWH scores,however,the difference in the predictive between the TASH and PWH scores was notstatistically significant (P>0.05).Conclusions:(1): MT at a very early stage after trauma patients had an higher Injure Severity Score.(2):With four score increase, percentage of massive transfusion has increase.(3): Weighted scores systems such as TASH and PWH scores performs superior oversimple non-weighted models in predictability for MT.However,the difference in thepredictive ability between the TASH and ABC scores was not statisticallysignificant.Recommend the PWH score used in trauma center in our country.