The Extremity/Mechanism/Shock Index/GCS (EMS-G) score: A novel pre-hospital scoring system for early and appropriate MTP activation
| Autor: | Heather Carmichael, Alexandra Kovar, Jacob Mago, Erik D. Peltz, Robert C. McIntyre, Alicia A. Heelan Gladden, Franklin L. Wright |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Emergency Medical Services medicine.medical_specialty Colorado Scoring system Shock Hemorrhagic 030204 cardiovascular system & hematology Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine Trauma Centers Predictive Value of Tests Blood product Internal medicine medicine Humans Trauma team Blood Transfusion Retrospective Studies Trauma Severity Indices business.industry Trauma center Extremities 030208 emergency & critical care medicine General Medicine Odds ratio Middle Aged Stepwise regression Shock index Massive transfusion Female Surgery business |
| Zdroj: | The American Journal of Surgery. 218:1195-1200 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2019.08.019 |
| Popis: | Background Numerous in-hospital scoring systems to activate massive transfusion protocols (MTP) have been proposed; however, to date, pre-hospital scoring systems have not been robustly validated. Many trauma centers do not have blood or pre-thawed plasma available in the trauma bay, leading to delays in balanced transfusion. This study aims to assess pre-hospital injury and physiologic parameters to develop a pre-hospital scoring system predictive of need for massive transfusion (MT) prior to patient arrival. Methods A retrospective review of all adult full and partial trauma team activations from July 2014–July 2018 from an urban level 2 trauma center was performed utilizing our trauma registry. Stepwise logistic regression analysis was performed to develop a new scoring system, with point totals assigned proportional to the odds ratios of requiring MT for each variable. Internal validation of the EMS-G score was performed using a subset of the data which was not utilized for development of the scoring system, and sensitivity and specificity were compared to previously validated in-hospital scoring systems applied in the pre-hospital setting. Results 763 patients were included with 94 patients (12.3%) receiving early MT, defined as 4 units pRBC in 4 h or ED death. In-hospital models for predicting MT such as Assessment of Blood Consumption (ABC) or Shock Index (SI) have sensitivities and specificities of 46/85% and 94/79% respectively for early MTP utilization based on pre-hospital data. Pre-hospital variables found to be predictive of MT were used to develop the EMS-G (Extremity, Mechanism, Shock Index, GCS) score. This system assigns obvious extremity injury–1-point, penetrating mechanism −2 points, shock index ≥0.9–2 points, GCS ≤8–3 points. A score of 3 or greater was chosen to maximize sensitivity and specificity for pre-hospital MT activation. EMS-G score based on pre-hospital report is 89% sensitive, 84% specific, with a PPV of 44% and NPV of 98% for early MT. Using this system, 25% of full and partial trauma team activations met criteria for pre-hospital MTP activation. Conclusion The EMS-G Score has increased sensitivity and specificity compared to the ABC Score in the pre-hospital setting and appears more appropriate than shock index alone at predicting massive transfusion. This scoring system allows trauma centers to activate MTP prior to patient arrival to ensure early and appropriate blood product administration without blood product wastage. |
| Databáze: | OpenAIRE |
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