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1.
Crit Care ; 22(1): 113, 2018 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-29728151

RESUMO

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.


Assuntos
Serviços Médicos de Emergência/métodos , Hemorragia/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Adulto , Transfusão de Sangue/métodos , Transfusão de Sangue/estatística & dados numéricos , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Hemorragia/fisiopatologia , Hemorragia/cirurgia , Humanos , Escala de Gravidade do Ferimento , Ácido Láctico/análise , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Paris , Estudos Prospectivos , Curva ROC , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Escore Fisiológico Agudo Simplificado , Estatísticas não Paramétricas , Ferimentos não Penetrantes/cirurgia
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