Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
Copyright © 2019 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: DHL. Data curation: YHP, DHR. Formal analysis & Methodology: DHL. Project administration: DHR. Visualization: DHL. Writing - original draft: YHP, BKL. Writing - reviewing & editing: BKL, DHL.
Values are presented as median (interquartile range) or number (%).
MT: massive transfusion; AIS: Abbreviated Injury Scale; SBP: systolic blood pressure; AST: aspartate transaminase; ALT: alanine aminotransferase; aPTT: activated partial thromboplastin time; PT-INR: international normalized ratio of prothrombin time; PRC: packed red blood cells; FFP: fresh frozen plasma; PC: platelet concentrates; ICU: intensive care unit.
Values are presented as median (interquartile range) or number (%).
MT: massive transfusion; TBI: traumatic brain injury; SBP: systolic blood pressure; WBC: white blood cell count; AST: aspartate transaminase; ALT: alanine aminotransferase; aPTT: activated partial thromboplastin time; PT-INR: international normalized ratio of prothrombin time; PRC: packed red blood cells; FFP: fresh frozen plasma; PC: platelet concentrates; ICU: intensive care unit.
Variable | All patients (N=553) | No MT (n=491) | MT (n=62) | P-value |
---|---|---|---|---|
Age (yr) | 59 (45–72) | 59 (46–73) | 57 (37–72) | 0.269 |
Male sex | 411 (74.3) | 364 (74.1) | 47 (75.8) | 0.776 |
Medical history | ||||
Hypertension | 163 (29.5) | 150 (30.5) | 13 (21.) | 0.119 |
Diabetes | 94 (17.0) | 88 (17.9) | 6 (9.7) | 0.103 |
Renal impairment | 5 (0.9) | 4 (0.8) | 1 (1.6) | 0.532 |
Mechanism of trauma | 0.008 | |||
Blunt | 542 (98.0) | 484 (98.6) | 58 (93.5) | |
Penetrating | 11 (2.0) | 7 (1.4) | 4 (6.5) | |
Injury Severity Score (AIS) | 22 (17–27) | 22 (17–25) | 26 (20–34) | <0.001 |
Head/neck | 2 (0–4) | 2 (0–4) | 0 (0–3) | 0.124 |
Face | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0.079 |
Chest | 3 (0–3) | 3 (0–3) | 2 (0–3) | 0.330 |
Abdomen | 0 (0–3) | 0 (0–3) | 3 (0–4) | <0.001 |
Extremity/pelvic | 2 (0–3) | 2 (0–2) | 2 (0–3) | 0.019 |
External | 0 (0–1) | 0 (0–1) | 0 (0–1) | 0.369 |
Revised Trauma Score | 7.84 (6.13–7.84) | 7.84 (6.38–7.84) | 6.38 (4.34–7.11) | <0.001 |
Glasgow Coma Scale | 15 (9–15) | 15 (9–15) | 14 (5–15) | 0.005 |
SBP (mm Hg) | 110 (80–130) | 110 (90–130) | 75 (60–100) | <0.001 |
Respiratory rate (/min) | 20 (20–22) | 20 (20–22) | 21 (20–24) | 0.058 |
Pulse rate (/min) | 88 (80–102) | 88 (80–100) | 99 (78–120) | 0.031 |
Laboratory test | ||||
White blood cell count (×109/L) | 15.1 (10.4–19.1) | 15.1 (10.5–19.0) | 14.8 (10.1–20.5) | 0.631 |
Hemoglobin (g/dl) | 11.5 (9.8–13.3) | 11.8 (10.0–13.5) | 9.8 (7.9–11.2) | <0.001 |
Platelet count (×109/L) | 192 (150–233) | 194 (154–237) | 156 (124–216) | 0.002 |
AST (U/L) | 66 (37–152) | 66 (37–143) | 84 (37–287) | 0.203 |
ALT (U/L) | 39 (23–91) | 39 (23–86) | 42 (23–171) | 0.559 |
aPTT (sec) | 31.4 (27.4–37.6) | 30.7 (27.0–35.8) | 38.9 (31.6–66.8) | <0.001 |
PT-INR | 1.16 (1.07–1.33) | 1.14 (1.06–1.28) | 1.32 (1.17–1.80) | <0.001 |
Lactate (mmol/L) | 2.9 (1.7–4.9) | 2.7 (1.6–4.3) | 5.5 (3.8–9.0) | <0.001 |
Base deficit | 3.7 (0.8–7.4) | 3.2 (0.5–6.4) | 8.5 (4.8–14.0) | <0.001 |
PRC (unit) | 2 (0–5) | 2 (0–4) | 13 (11–16) | <0.001 |
FFP (unit) | 2 (0–4) | 0 (0–3) | 9 (6–14) | <0.001 |
PC (unit) | 0 (0–8) | 0 (0–0) | 10 (8–17) | <0.001 |
Emergency operation | 148 (26.8) | 111 (22.6) | 37 (59.7) | <0.001 |
Emergency intervention | 84 (15.2) | 73 (14.9) | 11 (17.7) | 0.776 |
Hospital length of stay (day) | 18 (10–34) | 18 (10–32) | 21 (2–52) | 0.884 |
ICU length of stay (day) | 4 (2–10) | 4 (2–9) | 7 (2–16) | 0.026 |
In-hospital mortality | 80 (14.8) | 54 (11.0) | 26 (41.9) | <0.001 |
30-Day mortality | 91 (16.5) | 64 (13.0) | 27 (43.5) | <0.001 |
Variable | TBI patient (n=244) |
Non-TBI patient (n=309) |
||||
---|---|---|---|---|---|---|
No MT (n=219) | MT (n=25) | P-value | No MT (n=272) | MT (n=37) | P-value | |
Age (yr) | 64 (49–74) | 52 (37–72) | 0.122 | 57 (42–70) | 57 (36–72) | 0.994 |
Male sex | 159 (72.6) | 19 (76.0) | 0.717 | 205 (75.4) | 28 (75.7) | 0.967 |
Medical history | ||||||
Hypertension | 73 (33.3) | 5 (20.0) | 0.176 | 77 (28.3) | 8 (21.6) | 0.393 |
Diabetes | 44 (20.1) | 3 (12.0) | 0.331 | 44 (16.2) | 3 (8.1) | 0.200 |
Renal impairment | 2 (0.9) | 0 | 0.631 | 2 (0.7) | 1 (2.7) | 0.252 |
Mechanism of trauma | 0.063 | 0.045 | ||||
Blunt | 218 (99.5) | 24 (96.0) | 266 (97.8) | 34 (91.9) | ||
Penetrating | 1 (0.5) | 1 (4.0) | 6 (2.2) | 3 (8.1) | ||
Injury Severity Score | 25 (19–29) | 27 (22–35) | 0.014 | 20 (17–24) | 25 (18–34) | <0.001 |
Revised Trauma Score | 6.90 (5.03–7.84) | 5.44 (2.63–6.38) | <0.001 | 7.84 (7.11–7.84) | 6.38 (5.97–7.48) | <0.001 |
Glasgow Coma Scale | 10 (5–15) | 6 (3–13) | 0.030 | 15 (15–15) | 15 (12–15) | 0.002 |
SBP (mm Hg) | 120 (100–140) | 70 (60–95) | <0.001 | 100 (80–120) | 80 (55–105) | <0.001 |
Respiratory rate (/min) | 20 (20–22) | 22 (20–24) | 0.079 | 20 (20–22) | 20 (20–24) | 0.312 |
Pulse rate (/min) | 90 (80–100) | 100 (79–115) | 0.168 | 88 (80–100) | 94 (76–121) | 0.093 |
Laboratory test | ||||||
WBC (×109/L) | 14.9 (10.6–18.0) | 14.3 (9.8–19.6) | 0.804 | 15.3 (10.2–20.1) | 15.8 (11.0–20.9) | 0.499 |
Hemoglobin (g/dl) | 12.2 (10.3–13.7) | 10.1 (7.9–11.3) | <0.001 | 11.4 (9.8–13.2) | 9.5 (7.7–11.2) | <0.001 |
Platelet count (×109/L) | 194 (154–233) | 148 (111–223) | 0.057 | 197 (155–238) | 156 (129–210) | 0.014 |
AST (U/L) | 57 (34–107) | 51 (33–277) | 0.581 | 73 (40–208) | 108 (42–329) | 0.318 |
ALT (U/L) | 35 (19–62) | 35 (17–164) | 0.936 | 44 (25–125) | 47 (24–177) | 0.635 |
aPTT (sec) | 30.7 (26.9–37.2) | 49.6 (30.4–76.9) | <0.001 | 30.9 (27.0–35.6) | 38.4 (31.6–44.9) | <0.001 |
PT-INR | 1.15 (1.06–1.30) | 1.53 (1.10–1.83) | <0.001 | 1.14 (1.06–1.28) | 1.29 (1.18–1.53) | <0.001 |
Lactate (mmol/L) | 3.3 (2.2–5.4) | 5.3 (3.4–9.1) | 0.002 | 2.3 (1.4–3.4) | 5.6 (3.9–8.8) | <0.001 |
Base deficit | 3.1 (0.5–6.8) | 7.4 (3.2–14.2) | <0.001 | 3.3 (0.5–6.3) | 9.4 (5.3–14.1) | <0.001 |
PRC (unit) | 2 (0–4) | 13 (11–16) | <0.001 | 2 (0–4) | 13 (11–16) | <0.001 |
FFP (unit) | 0 (0–2) | 8 (5–12) | <0.001 | 0 (0–4) | 11 (7–14) | <0.001 |
PC (unit) | 0 (0–0) | 10 (8–14) | <0.001 | 0 (0–0) | 10 (3–17) | <0.001 |
Emergency operation | 46 (21.0) | 13 (52.0) | <0.001 | 65 (23.9) | 24 (64.9) | <0.001 |
Emergency intervention | 14 (6.4) | 5 (20.0) | 0.016 | 59 (21.7) | 6 (16.2) | 0.443 |
Hospital length of stay (day) | 16 (8–32) | 19 (3–52) | 0.567 | 19 (12–32) | 25 (2–57) | 0.725 |
ICU length of stay (day) | 7 (3–14) | 8 (2–28) | 0.436 | 3 (1–6) | 7 (2–13) | 0.009 |
In-hospital mortality | 42 (19.2) | 11 (44.0) | 0.004 | 12 (4.4) | 15 (40.5) | <0.001 |
30-Day mortality | 48 (21.9) | 11 (44.0) | 0.015 | 16 (5.9) | 16 (43.2) | <0.001 |
Variable | AUC (95% CI) |
||
---|---|---|---|
Total patient | TBI patient | Non-TBI patient | |
Injury Severity Score | 0.651 (0.609–0.690) | 0.649 (0.586–0.709) | 0.666 (0.610–0.718) |
Revised Trauma Score | 0.717 (0.677–0.754) | 0.731 (0.670–0.785) | 0.745 (0.693–0.793) |
Hemoglobin | 0.726 (0.687–0.763) | 0.717 (0.656–0.773) | 0.728 (0.675–0.777) |
Systolic blood pressure | 0.768 (0.730–0.802) | 0.809 (0.754–0.857) | 0.728 (0.675–0.777) |
Lactate level | 0.779 (0.742–0.813) | 0.690 (0.627–0.747) | 0.842 (0.796–0.881) |
Variable | Cutoff | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) |
---|---|---|---|---|---|
Lactate level (mmol/L) | |||||
Total patients | >3.7 | 75.8 (63.3–85.8) | 68.4 (64.1–72.5) | 23.3 (20.0–26.9) | 95.7 (93.5–97.2) |
TBI patient | >5.0 | 60.0 (38.7–78.9) | 74.9 (68.6–80.5) | 21.4 (15.5–28.8) | 94.3 (91.0–96.4) |
Non-TBI patient | >3.6 | 81.1 (64.8–92.0) | 77.2 (71.8–82.1) | 32.6 (27.0–38.8) | 96.8 (93.9–98.3) |
Variable | All patients |
TBI patient |
Non-TBI patient |
|||
---|---|---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | |
Mechanism | 0.178 (0.041–0.768) | 0.021 | 0.195 (0.011–3.442) | 0.265 | 0.139 (0.023–0.854) | 0.033 |
Injury Severity Score | 1.026 (0.990–1.063) | 0.155 | 1.010 (0.966–1.056) | 0.657 | 1.110 (1.040–1.185) | 0.002 |
Revised Trauma Score | 1.077 (0.875–1.325) | 0.486 | 1.106 (0.790–1.547) | 0.557 | 1.003 (0.674–1.492) | 0.987 |
Systolic blood pressure (mm Hg) | 0.979 (0.968–0.990) | <0.001 | 0.966 (0.953–0.980) | <0.001 | 0.991 (0.973–1.009) | 0.308 |
Pulse rate (/min) | 0.998 (0.984–1.012) | 0.760 | - | - | 0.995 (0.975–1.016) | 0.652 |
Hemoglobin (g/dl) | 0.834 (0.740–0.940) | 0.003 | 0.930 (0.808–1.069) | 0.308 | 0.704 (0.582–0.851) | <0.001 |
Platelet count (×109/L) | 1.000 (0.995–1.004) | 0.888 | 1.001 (0.993–1.009) | 0.840 | 0.997 (0.989–1.004) | 0.388 |
aPTT (sec) | 1.005 (0.990–1.019) | 0.524 | 1.005 (0.994–1.016) | 0.401 | 0.987 (0.954–1.021) | 0.437 |
PT-INR | 0.713 (0.462–1.101) | 0.127 | 0.773 (0.452–1.322) | 0.347 | 0.226 (0.076–0.671) | 0.007 |
Lactate (mmol/L) | 1.179 (1.070–1.299) | <0.001 | 1.002 (0.843–1.190) | 0.985 | 1.469 (1.262–1.710) | <0.001 |
Values are presented as median (interquartile range) or number (%). MT: massive transfusion; AIS: Abbreviated Injury Scale; SBP: systolic blood pressure; AST: aspartate transaminase; ALT: alanine aminotransferase; aPTT: activated partial thromboplastin time; PT-INR: international normalized ratio of prothrombin time; PRC: packed red blood cells; FFP: fresh frozen plasma; PC: platelet concentrates; ICU: intensive care unit.
Values are presented as median (interquartile range) or number (%). MT: massive transfusion; TBI: traumatic brain injury; SBP: systolic blood pressure; WBC: white blood cell count; AST: aspartate transaminase; ALT: alanine aminotransferase; aPTT: activated partial thromboplastin time; PT-INR: international normalized ratio of prothrombin time; PRC: packed red blood cells; FFP: fresh frozen plasma; PC: platelet concentrates; ICU: intensive care unit.
AUC: area under the curve; CI: confidence interval; TBI: traumatic brain injury.
CI: confidence interval; PPV: positive predictive value; NPV: negative predictive value; TBI: traumatic brain injury.
TBI: traumatic brain injury; OR: odds ratio; CI: confidence interval; aPTT: activated partial thromboplastin time; PT-INR: international normalized ratio of prothrombin time.