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Multicenter Validation of the Revised Assessment of Bleeding and Transfusion (RABT) Score for Predicting Massive Transfusion

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Abstract

Background

Massive transfusion (MT) is a lifesaving treatment for hemorrhaging patients. Predicting the need for MT is crucial to improve survival. The aim of our study was to validate the Revised Assessment of Bleeding and Transfusion (RABT) score to predict MT in a multicenter cohort of trauma patients.

Methods

We performed a (2015–2017) analysis of adult (age ≥ 18 year) trauma patients who had a high-level trauma team activation at three Level I trauma centers. The RABT was calculated using the 4-point score [blunt (0)/penetrating trauma (1), shock index ≥ 1 (1), pelvic fracture (1), and FAST positive (1)]. A RABT score of ≥ 2 was used to predict MT (≥ 10 units of packed red blood cells within 24 h). The area under the receiver operating characteristic curve (AUROC) was calculated to assess the score’s predictive power compared to the Assessment of Blood Consumption (ABC) score.

Results

We analyzed 1018 patients: 216 (facility I), 363 (facility II), and 439 (facility III). The mean age was 41 ± 19 year, and the injury severity score (ISS) was 29 [22–36]. The overall MT rate was 19%. The overall AUROC of RABT ≥ 2 was 0.89. The sensitivity of the RABT ≥ 2 was 78%, and the specificity was 91%. The RABT score had a higher sensitivity (78% vs. 69%) and specificity (91% vs. 82%) than the ABC score.

Conclusion

The RABT score is a valid tool to predict MT in severely injured trauma patients. It is an objective score that aids clinicians in predicting the need for MT to mobilize blood products and minimize the waste of resources.

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Funding

The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript. The appropriate institutions’ research ethics committees approved the study. Informed consent was waived.

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Authors and Affiliations

  1. Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA

    Kamil Hanna, Mohammad Hamidi & Bellal Joseph

  2. Divsion of Trauma, Acute Care Surgery, and Critical Care, Tulane University School of Medicine, New Orleans, LA, USA

    Charles Harris

  3. Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA

    Marc D. Trust & Carlos Brown

  4. Section of Trauma and Acute Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA

    Andrew Bernard

Authors
  1. Kamil Hanna
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  2. Charles Harris
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  3. Marc D. Trust
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  4. Andrew Bernard
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  5. Carlos Brown
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  6. Mohammad Hamidi
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  7. Bellal Joseph
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Correspondence to Bellal Joseph.

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Hanna, K., Harris, C., Trust, M.D. et al. Multicenter Validation of the Revised Assessment of Bleeding and Transfusion (RABT) Score for Predicting Massive Transfusion. World J Surg 44, 1807–1816 (2020). https://doi.org/10.1007/s00268-020-05394-5

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  • DOI: https://doi.org/10.1007/s00268-020-05394-5

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