Abstract
Background
Early damage control resuscitation and massive transfusion (MT) protocol activations
improve outcomes in trauma patients with hemorrhagic shock, where scores to guide
MT prediction are used including: the Assessment of Blood Consumption (ABC), Shock
Index (SI), and Revised Assessment of Bleeding and Transfusion (RABT) scores. Our
aim was to validate the RABT score in patients from two level I trauma centers in
Canada.
Methods
A retrospective review of adult patients meeting trauma team activation criteria receiving
>1 unit of red blood cells (RBCs) within 24 h of admission, from 2015 to 2020, was
conducted. A RABT score ≥ 2, ABC score ≥ 2, and Shock Index (SI) ≥ 1 was used to predict
MT using both research (≥10 RBCs in 24 h) and clinical (≥3 RBCs in 3 h) definitions.
Scores were assessed and compared using sensitivity, specificity, and the area under
the receiver operating characteristic (AUROC).
Results
We analyzed 514 patients with a mean age of 44.4 (19.2) years and a median injury
severity score of 29 [18–38]. For both MT definitions, the RABT score trended towards
higher sensitivity and lower specificity compared to ABC score and SI. For both research
and clinical definitions of MT, the AUROC for the RABT score was not significantly
higher (Research - RABT: 0.673 [0.610–0.735], ABC: 0.642 [0.551–0.734], SI 0.691 [0.625–0.757];
Clinical - RABT: 0.653 [0.608–0.698], ABC: 0.646 [0.600–0.691], SI 0.610 [0.559–0.660]).
Conclusion
The RABT score is a valid tool for predicting the need for MTPs, performing similarly
with a trend towards higher sensitivity when compared to the ABC score and SI.
Keywords
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Article info
Publication history
Published online: September 17, 2022
Accepted:
September 15,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
