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Background
Blood products are a valuable resource in the treatment of acute hemorrhage following trauma. Blood products must be used in a sensible and individually targeted manner to avoid unnecessary resource allocation and minimize the risk of unnecessary transfusion reactions.
The preclinical stockpiling and application of blood products is taking place on an increasingly large scale, even if the relevance to the outcome of patient care cannot be assessed reliably yet [1, 2–3].
The early use of blood products has a positive influence on patient condition and survival in the early phase after a severe trauma, which justifies prehospital or at least early hospital transfusion in the trauma resuscitation phase [4, 5]. Furthermore, the time factor also appears to be decisive regarding the evidence [6, 7–8].
There are multiple scores to predict the need for massive transfusion in trauma [9]. To identify patients with a potential need for early transfusion, we initially chose two different scores to identify items, that are easily available in the prehospital setting and documented within the datasets of the TraumaRegister DGU® (TR-DGU) to conduct this study. The first score - that was also used by Frieler et al. to predict mortality after trauma [10]- is the “Reverse shock index multiplied by Glasgow Coma Scale score” (rSIG)-score, consisting of the systolic blood pressure divided through heart rate and multiplied with the Glasgow-Coma-Scale value [rSIG= (systolic blood pressure/heart rate)*Glasgow Coma Sscale] on scene taking hemodynamic impairment and resulting organ dysfunction into account. In comparison to other known prediction scores for massive transfusions, the rSIG score can already be reliably determined preclinically. With an area under the receiver operating characteristics curve (AUROC) of 0.84 (95% CI 0.72–0.81) it also has good predictive quality (sensitivity 0.79, specificity 0.77) at a Cut-off value of 9.51 [11].
As a second score we used the Assessment of Blood Consumption (ABC) score to estimate the need for early transfusion. The ABC score is calculated out of the following items: (1) systolic blood pressure < 90 mmHg, (2) heart rate > 120 bpm, (3) positive FAST exam and (4) penetrating injury to the thorax. With a described AUROC of 0.763 (95% CI 0.732–0.794; sensitivity 76.1%, specificity 70.3%) at a cut off value of 2 points, it also provides a reasonable predictive...