Pediatric Modification of the Assessment of Blood Consumption Score Predicts the Need for Blood Transfusion in Trauma
*ibrahim Abd el-shafy1, Jeremy Fama1, Meredith Akerman2, *Francesca Bullaro1, *Nathan A.M. Christopherson1, *José M. Prince1
1Cohen Children's Medical Center, New Hyde Park, NY;2Feinstein Institute for Medical Research, Manhasset, NY
A predictive scoring system, the Assessment of Blood Consumption(ABC)-score, was validated to identify adult trauma patients who require a massive transfusion. The ABC-score consists of penetrating mechanism, positive focused assessment sonography for trauma(FAST) exam, arrival systolic blood pressure<90mmHg, and arrival heart rate>120bpm. The aim of this study is to evaluate whether the ABC-score can be adapted to predict the need for blood transfusions in pediatric trauma. Methods: Retrospective review of 2011-2014 National Trauma Data Bank(NTDB) including pediatric patients(age<15) with Injury Severity Score(ISS)>15 was conducted. Blood transfusions within the first 48hrs were identified using ICD-9. ABC-score criteria were age-adjusted and modified. A receiver operating characteristic(ROC) curve demonstrated the final model’s ability to predict the need for pediatric blood transfusion. The Hosmer and Lemeshow Goodness-of-Fit test evaluated the predictive status of the model. Results: Low blood pressure(BP), elevated heart rate(HR), Glasgow Coma Score(GCS) total, temperature <35°C, and penetrating mechanism were all significantly associated with blood transfusion. The model incorporating BP, HR, GCS, and temperature was the best predictor of blood transfusion(AUC=0.78). ABC-score≥1 had a sensitivity of 78%, specificity of 74% and correctly classified 78.4% of patients. Conclusion: The pediatric ABC-score has a good specificity and sensitivity for predicting the need for blood transfusions. Including GCS and temperature improved the accuracy of identifying the need for blood transfusion, highlighting the importance of understanding the role of brain injury in pediatric trauma. Prospective studies are required to evaluate the ability of our adapted pediatric ABC-score to predict the need for blood products and the impact on resource utilization in pediatric trauma.
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