Blunt Trauma Massive Transfusion (B-MaT) Score: A Novel Scoring Tool

Noncavitary torso hemorrhage is a rare and poorly characterized injury that can lead to exsanguination if not promptly addressed. When present in a high-risk patient on therapeutic anticoagulation, it can lead to a swift fatal outcome. Two cases (an 80-year-old female on warfarin and a 67-year-old male on apixaban for atrial fibrillation) presented with shock after direct blunt trauma in their torsos. Embolotherapy techniques were utilized to obtain angiostasis while the patients were resuscitated with massive transfusion protocols and reversal of the agents received. In the setting of severe localized blunt trauma on an aging victim while on antithrombotic medications, noncavitary torso hemorrhage must be included in the differential diagnosis. Local expertise and a high level of suspicion were critical in the early intervention, and postprocedural management of the injuries sustained and secured a good result.

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Abstract 184: Consideration of the Patient’s Age Is Important to Predict the Need for Massive Transfusion in Patients with Severe Blunt Trauma

Circulation ◽

10.1161/circ.130.suppl_2.184 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Takayuki Ogura ◽

Kenji Fujizuka ◽

Minoru Nakano ◽

Mitsunobu Nakamura

Keyword(s):

Trauma Patient ◽

Blunt Trauma ◽

Pelvic Fracture ◽

Injury Severity ◽

Massive Transfusion ◽

Multiple Logistic Regression Analysis ◽

Serum Lactate ◽

Trauma Patients ◽

Unstable Pelvic Fracture ◽

Age Related

Back Ground: The aging of society is progressing rapidly, and the aging of the trauma patient has also progressed over time. Age-related physiologic or anatomic loss of organ function, muscle atrophy, osteoporosis, and reduction in the average amount of subcutaneous tissue may lead to more serious effects of a traumatic injury. The aim of this study is to investigate the effect of patient’s age in the need for massive transfusion. Material and Methods: This study was conducted at a single institution, all patients in this study experienced blunt traumatic injuries. Patients with out-of-hospital cardiac arrest or isolated head trauma were excluded. We reviewed data from severely injured trauma patients admitted between Jan. 2008 and Mar. 2012. The following parameters were evaluated: age, sex, systolic blood pressure (SBP), heart rate (HR), Glasgow Coma Scale (GCS), results of the Focused Assessment with Sonography for Trauma (FAST), unstable pelvic fracture, femoral fracture, serum lactate, base excess, hemoglobin level (Hb), platelet count (Plt), prothrombin time (PT), antithrombotic agents, active outer bleeding, and Injury Severity Score (ISS). Massive transfusion was defined as the transfusion of 10 or more units of packed red blood cells, within 24 hours of the time of injury. We compared the parameters in patients who underwent massive transfusion (the MT group) with those who did not (the non-MT group), and independent contributed variables were detected by multiple logistic regression analysis. Results: 232 patients were included. Age, positive FAST, serum lactate, active outer bleeding, the presence of unstable pelvic fracture, and ISS in the MT group were all significantly greater than in the non-MT group. SBP, GCS, Hb, Plt, and PT were significantly less in the MT group than in the non-MT group. Age (p=0.02), SBP (p<0.01), positive FAST (p<0.01), the presence of unstable pelvic fracture (p<0.01), PT (p=0.01), and ISS (p<0.01) were independent contributed variables for massive transfusion. Conclusion: Elderly blunt trauma patient tended to be transfused massively, and consideration of the patient’s age is important to predict the need for massive transfusion in severe blunt trauma patients.

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