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Overview :
Schreiber et al identified risk factors for massive
transfusion in a combat casualty soon after admission to the hospital. This can
help identify patients who may require more aggressive management and more vigorous
resuscitation. The authors are from Oregon Health and Science University,
Walter Reed Army Medical Center and Fort Sam Houston.
Massive transfusion: >= 10 units of blood (packed or
fresh whole) in the first 24 hours after admission.
Parameters based on admission data:
(1) hemoglobin
(2) INR
(3) mechanism of injury
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Parameter
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Finding
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Points
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hemoglobin
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> 11 g/dL
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0
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<= 11 g/dL
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1
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INR
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<= 1.5
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0
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> 1.5
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1
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mechanism of injury
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penetrating
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1
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other (blast, burn, etc)
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0
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where:
• The elevation
in INR is usually due to a coagulopathy triggered by release of tissue
thromboplastin in massive trauma.
• The odds
ratio for hemoglobin was approximately 8; for INR 6 and penetrating mechanism
3.
• Most
casualties had fluid resuscitation in the field and a transport time of 20-60
minutes.
total number of risk factors =
= SUM(points for all 3 parameters)
Interpretation:
• minimum
number of risk factors: 0
• maximum number of risk factors: 3
• The risk of massivae transfusion increases with the number
of risk factors.
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