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Predicting the critical administration threshold in bleeding trauma patients.

Kevin Durr1,2, Krishan Yadav3,4, Michael Ho3

  • 1Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. kedurr@toh.ca.

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Early identification of trauma patients needing blood is crucial. Key indicators like low blood pressure and GCS score can predict the need for critical blood product administration, reducing preventable deaths.

Keywords:
Critical Administration ThresholdTransfusionTrauma

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Critical Care

Background:

  • Hemorrhagic injuries are a leading cause of preventable trauma deaths.
  • Timely recognition and management of bleeding are critical for patient survival.

Purpose of the Study:

  • To identify patient variables available upon emergency department arrival that predict the need for critical blood product administration.
  • To improve early recognition of severe hemorrhage in trauma patients.

Main Methods:

  • Retrospective trauma registry review (September 2016 - March 2020).
  • Analysis of trauma team activations at a Level 1 Trauma Center.
  • Multivariate logistic regression to identify predictors of critical blood administration.

Main Results:

  • 762 patients assessed; 10.2% met the critical administration threshold.
  • Four variables predicted critical administration: SBP ≤ 90 mmHg, GCS ≤ 8, HR ≥ 100 bpm, RR ≥ 20 bpm.
  • Median time to critical administration was 28.9 minutes.

Conclusions:

  • Systolic blood pressure ≤ 90 mmHg, Glasgow Coma Scale ≤ 8, heart rate ≥ 100 bpm, and respiratory rate ≥ 20 bpm are key predictors.
  • Physicians should consider immediate blood product orders for patients presenting with these indicators.