دورية أكاديمية
أعرض في EDS

Outcomes of patients enrolled in a prospective and randomized trial on basis of gestalt assessment or ABC score.

التفاصيل البيبلوغرافية
العنوان: Outcomes of patients enrolled in a prospective and randomized trial on basis of gestalt assessment or ABC score.
المؤلفون: Baird EW; From the Department of Surgery (E.W.B., P. J. A.), Center for Injury Science (D.T.L., Z.G.H., R.L.G., S.W.S., J.O.J., J.B.H.), University of Alabama at Birmingham, Birmingham, AL., Lammers DT, Abraham PJ, Hashmi ZG, Griffin RL, Stephens SW, Jansen JO, Holcomb JB
المصدر: The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 Jun 01; Vol. 96 (6), pp. 876-881. Date of Electronic Publication: 2024 Feb 12.
نوع المنشور: Clinical Trial, Phase III; Journal Article; Multicenter Study; Randomized Controlled Trial
اللغة: English
بيانات الدورية: Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101570622 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2163-0763 (Electronic) Linking ISSN: 21630755 NLM ISO Abbreviation: J Trauma Acute Care Surg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins
مواضيع طبية MeSH: Wounds and Injuries*/therapy , Wounds and Injuries*/mortality, Adult ; Female ; Humans ; Male ; Middle Aged ; Blood Transfusion/statistics & numerical data ; Gestalt Theory ; Hemorrhage/mortality ; Hemorrhage/therapy ; Injury Severity Score ; Prospective Studies
مستخلص: Background: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial rapidly enrolled patients based on an Assessment of Blood Consumption (ABC) ≥ 2 score, or physician gestalt (PG) when ABC score was <2. The objective of this study was to describe what patients were enrolled by the two methods and whether patient outcomes differed based on these enrollments. We hypothesized that there would be no differences in outcomes based on whether patients were enrolled via ABC score or PG.
Methods: Patients were enrolled with an ABC ≥ 2 or by PG when ABC was <2 by the attending trauma surgeon. We compared 1-hour, 3-hour, 6-hour, 12-hour, 18-hour, and 24-hour mortality, 30-day mortality, time to hemostasis, emergent surgical or interventional radiology procedure and the proportion of patients who required either >10 units of blood in 24 hours or >3 units in 1 hour.
Results: Of 680 patients, 438 (64%) were enrolled on the basis of an ABC score ≥2 and 242 (36% by PG when the ABC score was <2). Patients enrolled by PG were older (median, 44; interquartile range [IQR], 28-59; p < 0.001), more likely to be White (70.3% vs. 60.3%, p = 0.014), and more likely to have been injured by blunt mechanisms (77.3% vs. 37.2%, p < 0.001). They were also less hypotensive and less tachycardic than patients enrolled by ABC score (both p < 0.001). The groups had similar Injury Severity Scores in the ABC ≥ 2 and PG groups (26 and 27, respectively) and were equally represented (49.1% and 50.8%, respectively) in the 1:1:1 treatment arm. There were no significant differences between the ABC score and PG groups for mortality at any point. Time to hemostasis (108 for patients enrolled on basis of Gestalt, vs. 100 minutes for patients enrolled on basis of ABC score), and the proportion of patients requiring a massive transfusion (>10 units/24 hours) (44.2% vs. 47.3%), or meeting the critical administration threshold (>3 unit/1 hour) (84.7% vs. 89.5%) were similar ( p = 0.071).
Conclusion: Early identification of trauma patients likely to require a massive transfusion is important for clinical care, resource use, and selection of patients for clinical trials. Patients enrolled in the PROPPR trial based on PG when the ABC score was <2 represented 36% of the patients and had identical outcomes to those enrolled on the basis of an ABC score of ≥2.
Level of Evidence: Prognostic and Epidemiological; Level III.
(Copyright © 2024 American Association for the Surgery of Trauma.)
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تواريخ الأحداث: Date Created: 20240212 Date Completed: 20240522 Latest Revision: 20240717
رمز التحديث: 20240718
DOI: 10.1097/TA.0000000000004276
PMID: 38342992
قاعدة البيانات: MEDLINE
الوصف
تدمد:2163-0763
DOI:10.1097/TA.0000000000004276