ABC Score for Massive Transfusion - MDCalc

The ABC Score for Massive Transfusion Determines need for massive transfusion in trauma patients. Thisisanunprecedentedtime.Itisthededicationofhealthcareworkersthatwillleadusthroughthiscrisis.Thankyouforeverythingyoudo.COVID-19ResourceCenterCalcFunctionCalcsthathelppredictprobabilityofadiseaseDiagnosisSubcategoryof'Diagnosis'designedtobeverysensitiveRuleOutDiseaseisdiagnosed:prognosticatetoguidetreatmentPrognosisNumericalinputsandoutputsFormulaMedtreatmentandmoreTreatmentSuggestedprotocolsAlgorithmDiseaseSelect...SpecialtySelect...ChiefComplaintSelect...OrganSystemSelect...PatentPendingLogInEmailAddressPasswordShowForgotyourpassword?LogInOrcreateanewaccount(it'sfree)ForgotPassword?EmailAddressEnteryouremailaddressandwe'llsendyoualinktoresetyourpassword.GetNewPasswordSignInRequiredTosavefavorites,youmustlogin.Creatinganaccountisfree,easy,andtakesabout60seconds.LogInCreateAccountAttentionCOACHSTUDYparticipants:Theprincipalinvestigatorsofthestudyrequestthatyouusetheofficialversionofthemodifiedscorehere.Saveyourunitpreferencesinsettings!LoginABCScoreforMassiveTransfusionPredictsneedformassivetransfusionintraumapatients.WhentoUsePearls/PitfallsWhyUseTraumapatientsforwhommassivetransfusionisbeingconsidered.  Doesnotrequirelaboratoryresultsorcomplexcalculations. TheFASTexamusedtodeterminethescorereliesontheskilllevelofthepersonperformingandinterpretingthestudy. Thescoretendstoovertriageinfavorofreceivingmassivetransfusion,ensuringalowchanceofwithholdingmassivetransfusionfromapatientthatneedsit.   Whilethescorecanhelpaidthedecisiontoinitiatemassivetransfusion,theleadphysician(s)managingthetraumashouldplacetheorder,asamassivetransfusioncanquicklystretchthelimitsofthehospitalbloodsupply. Earlyinitiationofmassivetransfusionhasbeenshowntoimprovesurvivalincriticaltraumapatients.TheABCScorereducesdelayindeterminingneedformassivetransfusioninatraumapatient,whilealsoprovidingconsistencyinappropriatenessoftransfusionbyreducingpracticevariationsamongproviders.PenetratingmechanismNo0Yes+1SystolicBP≤90inEDNo0Yes+1HR≥120inEDNo0Yes+1PositiveFASTNo0Yes+1Result:Pleasefilloutrequiredfields.NextStepsEvidenceCreatorInsightsDr.BryanCottonFromtheCreatorWhatrecommendationsdoyouhavefordoctorsoncetheyhaveappliedtheABCScore?Arethereanyadjustmentsorupdatesyouwouldmaketothescorebasedonnewdataorpracticechanges? OnceadoptedorincorporatedintoaprehospitalorEDmassivetransfusionprotocol,onecanevaluateforimpactontimingofdeliveryofproductsandforpotentialwastage.Whileitwasdevelopedtodeterminesuccessfulpredictionofpatientswhowouldreceive10unitsofRBCs,manymajortransfusionsinvolvelessthan10unitsinthecurrent1:1:1paradigmwherewegethemostasismuchsooner. Whatwehavedoneislookatpredictingthosewhoreceiveonecoolerofproducts(6RBCs,6plasma,"6-pack"platelets),ratherthan10unitsofRBCs.Attheendoftheday,it'sabouthavingtheproductsyourpatientneedsatthebedsidewhenyouneedthemandnotwaitingforthem.Youcanalwayssendtheproductsbackifyoudon'tendupneeding/usingthem(andshouldinanexpeditiousmanner). WhydidyoudeveloptheABCScore?Wasthereaparticularclinicalexperienceorpatientencounterthatinspiredyoutocreatethistoolforclinicians? WedevelopedtheABCScoretohelptoremindphysicianstoactivatetheirmassivetransfusionprotocol(MTP)quicker.Wesawatourhospitalthatdelaysinactivation(activatingitaslittleas10-15later)wereassociatedwithanalmost3-foldincreaseinmortality.Morerecently,wehaveshownthateveryminute(every60seconds!)delayinactivatingyourMTPafterpatientarrivalisassociatedwitha5%increaselikelihoodofmortality,asiseveryminutedelayinreceivingthecoolersonceactivated. Whatpearls,pitfallsand/ortipsdoyouhaveforusersoftheABCScore?Doyouknowofcaseswhenithasbeenapplied,interpreted,orusedinappropriately? ThebiggestpitfallorinappropriateuseisinsettingswhereyourED/traumateamdoesnotuseFAST/ultrasound(orisn'tveryfacilewithFAST).Intheinitialdevelopmentdatasetandinsubsequentvalidationdatasets,themostpowerfulpredictorofthefourindividualcomponentswaspositiveFAST.So,ifyouaregoingtousetheABC,youshouldbedoingFASToneverypatient(anddoingthemwell).  Inamulti-centervalidationstudy,theABCScoredemonstratedanegativepredictivevalueofover95%,meaningthatthescoremissedlessthan5%ofpatientswhoultimatelyreceivedamassivetransfusion.So,itwillgetproductstothebedsidewhenyouneedthem(eventhoughyoumaynotendupusingthemall),butwillonlymissbringingtheproductstothebedsideinasmallnumberofcases.  Whenlookingatyourprogramandseeingthatnotallpatientspredictedaregettingto10unitsofRBCsshouldn'tbeviewedasafailure.Thequestionis,isdidtheyget/needmultipleproductsinashorttimeframeafterbeingpredictedtoneedthem?Also,ifyouareseeingtrueproductwaste(ratherthanbloodbanktechtimeandMTPcooler"runner"timewastage),thenoneshouldlookatyourproducthandlingandtimelyreturnofproducts.Youshouldalwaysbeabletosendproductsbackinatimelyfashioninpatientsthatdonotendupneedingallorevensomeoftheproducts. Anyotherresearchinthepipelinethatyou'reparticularlyexcitedabout? WehaverecentlyshownthataprehospitalABCScoreisjustaspowerfulatpredictingnotonlyneedforMTP,butalsoemergencysurgery.OurhelicopterprogramusestheABCScoretobeginhangingwholeblood,RBCs,and/orplasmaintheprehospitalsettingandservesasanactivationcriteriaforourin-hospitalMTP. HowdoyouusetheABCScoreinyourownclinicalpractice?Canyougiveanexampleofascenarioinwhichyouuseit? Notonlyhaveweuseditasanentrycriteriaforseveralrandomizedtrials,weuseitlocallyonadailybasisinboththeprehospitalandEDsettingtoactivateourMTP.Therecentdataontimetoactivation,productdelivery,anditseffectonoutcomehasledustoplacetheseproductscloserandclosertothepatient.WenowhavenotonlyRBCsandplasmaonallourhelicoptersandinthetraumabay,butwehaverecentlyaddedwholebloodtoeachoftheseareastobringproductsquickertothepatientwhilewearewaitingfordeliveryoftheformalMTPcoolers.AbouttheCreatorBryanCotton,MD,MPH,isaprofessorinthedepartmentofsurgery,divisionofacutecaresurgeryattheUniversityofTexasHealthCenterinHouston.Heisanactiveresearcherinthefieldoftraumaandtraumaticinjury.ToviewDr.BryanCotton'spublications,visitPubMedContentContributorsCullenClark,MDRelatedCalcsTASHScoreFASTShockIndex,PediatricAge-Adjusted(SIPA)Havefeedbackaboutthiscalculator?AbouttheCreatorDr.BryanCottonAlsofromMDCalc...RelatedCalcsTASHScoreFASTShockIndex,PediatricAge-Adjusted(SIPA)Youmightbeinterestedin...PartnerContentCalculatedDecisions:ABCScoreEmergencyMedicinePracticeContentContributorsCullenClark,MD