Prehospital ABC Score Accurately Forecasts Patients Who Will Require Immediate Resource Utilization

Area of Science:

• Trauma care
• Emergency medicine
• Ultrasound in trauma assessment

Background:

• Scoring systems like the Assessment of Blood Consumption (ABC) Score aid in identifying patients requiring massive transfusion (MT).
• Aeromedical transport commonly utilizes Focused Assessment with Sonography for Trauma (FAST) examinations.

Purpose of the Study:

• To evaluate the Prehospital ABC (PhABC) Score's ability to predict blood transfusions and the need for emergent laparotomy in trauma patients during aeromedical transport.

Main Methods:

• A post hoc analysis of a prospective observational study involving trauma patients undergoing in-flight FAST.
• The PhABC Score was positive with ≥2 criteria: penetrating trauma, heart rate >120 bpm, systolic blood pressure <90 mm Hg, or positive abdominal FAST.
• Statistical evaluation included receiver operating characteristic (AUROC) curves and logistic regression.

Main Results:

• A positive PhABC Score predicted emergent laparotomy (AUROC 0.83) and MT (AUROC 0.77).
• FAST was the strongest predictor for both emergent laparotomy (OR 8.5) and MT (OR 5.9).
• High negative predictive values were observed for both outcomes (95% for laparotomy, 94% for MT).

Conclusions:

• The PhABC Score effectively predicts in-hospital resource needs in trauma patients.
• It helps reduce undertriage in the prehospital setting.
• The score facilitates trauma team activation, blood product mobilization, and operating room preparation.