Prediction of massive bleeding in a prehospital setting: Validation of six scoring systems

Abstract Objective To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. Design Retrospective cohort. Setting Prehospital attention of patients with severe trauma. Subjects Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid. Variables To validate: 1. Trauma Associated Severe Haemorrhage Score. 2. Assessment of Blood Consumption Score. 3. Emergency Transfusion Score. 4. Indice de Shock. 5. Prince of Wales Hospital/Rainer Score. 6. Larson Score. Results 548 subjects were studied, 76.8% (420) were male, median age was 38 (interquartile range [IQR]: 27–50). Injury Severity Score was 18 (IQR: 9–29). Blunt trauma represented 82.5% (452) of the cases. Overall, frequency of MB was 9.2% (48), median intensive care unit admission days was 2.1 (IQR: 0.8–6.2) and hospital mortality rate was 11.2% (59). Emergency Transfusion Score had the highest precisions (AUC 0.85), followed by Trauma Associated Severe Haemorrhage score and Prince of Wales Hospital/Rainer Score (AUC 0.82); Assessment of Blood Consumption Score was the less precise (AUC 0.68). Conclusion In the prehospital setting the application of any of the six scoring systems predicts the presence of massive hemorrhage and allows the activation of massive transfusion protocols while the patient is transferred to a hospital.