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Development of prehospital assessment findings associated with massive transfusion.

  • Wheeler, Abigail R1
  • Cuenca, Camaren2
  • Fisher, Andrew D3, 4
  • April, Michael D5
  • Shackelford, Stacy A6, 7
  • Schauer, Steven G2, 6, 8
  • 1 University of South Carolina School of Medicine, Columbia, South Carolina.
  • 2 US Army Institute of Surgical Research, San Antonio, Texas.
  • 3 Texas Army National Guard, Austin, Texas.
  • 4 Texas A&M College of Medicine, Temple, Texas.
  • 5 Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas.
  • 6 59th Medical Wing, JBSA Lackland, San Antonio, Texas.
  • 7 Joint Trauma System, JBSA Fort Sam Houston, San Antonio, Texas.
  • 8 Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Published Article
Wiley (Blackwell Publishing)
Publication Date
Jun 01, 2020
60 Suppl 3
DOI: 10.1111/trf.15595
PMID: 32478893


Massive transfusion is frequently a component of the resuscitation of combat casualties. Because blood supplies may be limited, activation of a walking blood bank and mobilization of necessary resources must occur in a timely fashion. The development of a risk prediction model to guide clinicians for early transfusion in the prehospital setting was sought. This is a secondary analysis of a previously described data set from the Department of Defense Trauma Registry from January 2007 to August 2016 focusing on casualties undergoing massive transfusion. Serious injury was defined based on an Abbreviated Injury Scale score of 3 or greater by body region. The authors constructed multiple imputations of the model for risk prediction development. Efforts were made to internally validate the model. Within the data set, there were 15540 patients, of which 1238 (7.9%) underwent massive transfusion. In the body region injury scale model, explosive injuries (odds ratio [OR], 3.78), serious extremity injuries (OR, 6.59), and tachycardia >120/min (OR, 5.61) were most strongly associated with receiving a massive transfusion. In the simplified model, major amputations (OR, 17.02), tourniquet application (OR, 6.66), and tachycardia >120 beats/min (OR, 8.72) were associated with massive transfusion. Both models had area under the curve receiver operating characteristic values of greater than 0.9 for the model and bootstrap forest analysis. In the body region injury scale model, explosive mechanisms, serious extremity injuries, and tachycardia were most strongly associated with massive transfusion. In the simplified model, major amputations, tourniquet application, and tachycardia were most strongly associated. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

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