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
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
Externí odkaz: