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Optimizing massive transfusion protocol activation: A new decision tool based on a Dutch trauma cohort
K F Berenschot1, M E Cnossen1, M R van Bohemen2
1Department of Anesthesiology, Erasmus Medical Centre, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
Background:
Most trauma centres have implemented a massive transfusion protocol (MTP) to facilitate the rapid transfusion of blood products. However, identifying patients who require transfusion remains challenging, which often results in overactivation. The primary objective of this study was to identify patient-related factors that could be used to accurately predict justified MTP activation, defined by the administration of at least 1 transfusion product after MTP activation.
Methods:
In this retrospective cohort study trauma patients for whom the MTP was activated in the Erasmus Medical Centre, Rotterdam, The Netherlands, from January 2018 until November 2024 were eligible for inclusion. Exclusion criteria were children, interhospital transfers and inaccessible patient files. Variables with the highest discriminative ability to accurately predict justified MTP activation were used to create a new decision tool. This new decision tool was compared with existing decision tools.
Results:
A total of 463 patients were included, 198 justified and 265 unjustified MTP activations. The variables and their cut-off points used for the new decision tool were pH ≤ 7.25, lactate ≥4.6 mmol/L, SBP ≤ 105 mmHg, DBP ≤ 60 mmHg, PP ≤ 45 mmHg, HR ≥ 110 beats per minute, temperature ≤ 35.8 °C, and a positive eFAST. This resulted in 92.1% sensitivity, 55.8% specificity, 60.4% positive predictive value and 90.6% negative predictive value.
Conclusion:
Patient-related factors to predict justified MTP activation were identified. With these variables, a new decision tool was developed that accurately predicted the need for MTP activation and could potentially diminish overactivation.