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Prediction of massive transfusion with the Revised Assessment of Bleeding and Transfusion (RABT) score at Canadian level I trauma centers

  • Karan D'Souza
    Correspondence
    Corresponding author at: Section of Acute Care Surgery and Trauma, Division of General Surgery Gordon & Leslie Diamond Health Care Centre, 11th floor 2775 Laurel St, Room 11123, Vancouver, BC, Canada V5Z 1M9.
    Affiliations
    Section of Acute Care Surgery and Trauma, Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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  • Mathew Norman
    Affiliations
    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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  • Adam Greene
    Affiliations
    AirEvac and Critical Care Operations, British Columbia Emergency Health Services, Vancouver, BC, Canada
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  • Colby J.F. Finney
    Affiliations
    Section of Acute Care Surgery and Trauma, Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    AirEvac and Critical Care Operations, British Columbia Emergency Health Services, Vancouver, BC, Canada

    Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

    Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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  • Matthew T.S. Yan
    Affiliations
    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    AirEvac and Critical Care Operations, British Columbia Emergency Health Services, Vancouver, BC, Canada
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  • Jacqueline D. Trudeau
    Affiliations
    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada

    Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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  • Michelle P. Wong
    Affiliations
    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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  • Andrew Shih
    Affiliations
    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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  • Philip Dawe
    Affiliations
    Section of Acute Care Surgery and Trauma, Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Published:September 17, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.022

      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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