Development and validation of a pre-hospital 'Red Flag' alert for activation of intra-hospital haemorrhage control response in blunt trauma
Autor: | Anatole Harrois, Tobias Gauss, Mathieu Raux, Olivier Langeron, Arié Attias, Mathieu Boutonnet, Fabrice Cook, Arnaud Follin, Guillaume de St Maurice, Romain Pirracchio, Catherine Paugam-Burtz, Sophie Hamada, Gilles Dhonneur, Sylvain Ausset, Alexandra Rouquette, Bernard Vigué, Jacques Duranteau, Anne Rosa, Jean-Philippe Desclefs, Bruno Riou |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Adult
Male Emergency Medical Services Paris Blood transfusion medicine.medical_treatment Hemorrhage Critical Care and Intensive Care Medicine Wounds Nonpenetrating Statistics Nonparametric Anticipation Cohort Studies 03 medical and health sciences 0302 clinical medicine Injury Severity Score Protocol Medicine Humans Severe trauma Blood Transfusion 030212 general & internal medicine Lactic Acid Prospective Studies Registries Prospective cohort study Retrospective Studies Simplified Acute Physiology Score Chi-Square Distribution Receiver operating characteristic medicine.diagnostic_test business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine Retrospective cohort study Interventional radiology lcsh:RC86-88.9 Middle Aged Severe haemorrhage ROC Curve Blunt trauma Anesthesia Female business Organization Cohort study |
Zdroj: | Critical Care, Vol 22, Iss 1, Pp 1-12 (2018) Critical Care |
ISSN: | 1364-8535 |
Popis: | Background Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures. Methods A multicentre retrospective study of prospectively collected data from a trauma registry (Traumabase®) was performed. SH was defined as: packed red blood cell (RBC) transfusion in the trauma room, or transfusion ≥ 4 RBC in the first 6 h, or lactate ≥ 5 mmol/L, or immediate haemostatic surgery, or interventional radiology and/or death of haemorrhagic shock. Pre-hospital characteristics were selected using a multiple logistic regression model in a derivation cohort to develop a Red Flag binary alert whose performances were confirmed in a validation cohort. Results Among the 3675 patients of the derivation cohort, 672 (18%) had SH. The final prediction model included five pre-hospital variables: Shock Index ≥ 1, mean arterial blood pressure ≤ 70 mmHg, point of care haemoglobin ≤ 13 g/dl, unstable pelvis and pre-hospital intubation. The Red Flag alert was triggered by the presence of any combination of at least two criteria. Its predictive performances were sensitivity 75% (72–79%), specificity 79% (77–80%) and area under the receiver operating characteristic curve 0.83 (0.81–0.84) in the derivation cohort, and were not significantly different in the independent validation cohort of 2999 patients. Conclusion The Red Flag alert developed and validated in this study has high performance to accurately predict or exclude SH. Electronic supplementary material The online version of this article (10.1186/s13054-018-2026-9) contains supplementary material, which is available to authorized users. |
Databáze: | OpenAIRE |
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