Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Factors for Predicting the Need for an Emergency Blood Transfusion to a Multiple Trauma Patient Using Emergency Room Transfusion Score (ETS)

다발성 외상 환자에서 Emergency Room Transfusion Score (ETS)를 이용한 응급수혈의 예측인자

  • Jo, Hyeon Kyu (Department of Emergency Medicine, College of Medicine, Chosun University) ;
  • Park, Yong Jin (Department of Emergency Medicine, College of Medicine, Chosun University) ;
  • Kim, Sun Pyo (Department of Emergency Medicine, College of Medicine, Chosun University) ;
  • Kim, Seong Jung (Department of Emergency Medicine, College of Medicine, Chosun University) ;
  • Cho, Soo Hyung (Department of Emergency Medicine, College of Medicine, Chosun University) ;
  • Cho, Nam Soo (Department of Emergency Medicine, College of Medicine, Chosun University)
  • 조현규 (조선대학교병원 응급의학과) ;
  • 박용진 (조선대학교병원 응급의학과) ;
  • 김선표 (조선대학교병원 응급의학과) ;
  • 김성중 (조선대학교병원 응급의학과) ;
  • 조수형 (조선대학교병원 응급의학과) ;
  • 조남수 (조선대학교병원 응급의학과)
  • Received : 2014.10.08
  • Accepted : 2015.01.06
  • Published : 2015.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS). Methods: This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed. Results: Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas received an emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died. Conclusion: During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture.

Keywords

References

  1. Ruchholtz S, Pehle B, Lewan U, Lefering R, Miller N, Oberbeck R. The emergency room transfusion score (ETS): prediction of blood transfusion requirement in initial resuscitation after severe trauma. Transfus Med 2006; 16: 49-56.
  2. Kuhne CA, Zettl RP, Fischbacher M, Lefering R, Ruchholtz S. Emergency transfusion score (ETS): A useful instrument for prediction of blood transfusion requirement in severely injured patients. World J Surg 2008; 32: 1183-8. https://doi.org/10.1007/s00268-007-9425-4
  3. Como JJ, Dutton RP, Scalea TM, Edelman BB, Hess JR, Blood transfusion rates in the care of acute trauma. Transfus 2004; 44: 809-13. https://doi.org/10.1111/j.1537-2995.2004.03409.x
  4. Teixeira PG, Oncel D, Demetriades D, Inaba K, Shulman I, Green D et al. B lood transfusion in trau- ma: six-year analysis of the transfusion practices at a Level I trauma center. Am Surg 2008; 74: 953-7.
  5. Fraga GP, Bansal V, Coimbra R. Transfusion of blood products in trauma :An update. J Emerg Med 2009; 36: 227-32. https://doi.org/10.1016/j.jemermed.2007.05.052
  6. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003; 54: 1127-30. https://doi.org/10.1097/01.TA.0000069184.82147.06
  7. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma 2003; 55: 39-44. https://doi.org/10.1097/01.TA.0000075338.21177.EF
  8. Yucel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S et al. Trauma associated severe hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after mulitple trauma. J Trauma 2006; 60: 1228-37. https://doi.org/10.1097/01.ta.0000220386.84012.bf
  9. Rainer TH, Ho AM, Yeung JH, Cheung NK, Wong RS, Tang N et al. Early risk stratification of patients with major trauma requiring massive blood transfusion. Resuscitation. 2011; 82: 724-9. https://doi.org/10.1016/j.resuscitation.2011.02.016
  10. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care 2011; 15: R191. https://doi.org/10.1186/cc10348
  11. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoipe M et al. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 2010; 38: 831-7. https://doi.org/10.1097/CCM.0b013e3181cc4a67
  12. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma 2003; 55: 39-44. https://doi.org/10.1097/01.TA.0000075338.21177.EF
  13. Hardy JF1, de Moerloose P, Samama CM. The coagulopathy of massive transfusion. Vox Sang 2005; 89: 123-7. https://doi.org/10.1111/j.1423-0410.2005.00678.x
  14. Kristen C. Sihler, MD, MS, Lena M. Napolitano, MD. Complications of Massive Transfusion. Chest 2010; 137: 209-20. https://doi.org/10.1378/chest.09-0252
  15. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006; 60: S3-11. https://doi.org/10.1097/01.ta.0000199961.02677.19
  16. Theusinger OM, Madjdpour C, Spahn DR. Resuscitation and transfusion management in trauma patients: emerging concepts. Curr Opin Crit Care 2012; 18: 661-70. https://doi.org/10.1097/MCC.0b013e328357b209
  17. Mahambrey TD, Fowler RA, Pinto R, Smith TS, Callum JL, Pisani NS et al. Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study. Can J Anaesth 2009; 56: 740-50. https://doi.org/10.1007/s12630-009-9151-5
  18. Ley EJ, Liou DZ, Singer MB, Mirocha J, Melo N, Chung R et al. Emergency department blood transfusion: the first two units are free. J Surg Res 2013; 184: 546-50. https://doi.org/10.1016/j.jss.2013.03.043
  19. Elmer J1, Wilcox SR, Raja AS. Massive transfusion in traumatic shock. J Emerg Med 2013; 44: 829-38. https://doi.org/10.1016/j.jemermed.2012.11.025