The use of ABC score in activation of massive transfusion: The Yin and the Yang

BACKGROUND Hemorrhage is the most common cause of early death in trauma patients. Massive Transfusion Protocols (MTP) have been designed to accelerate the release of blood products but can result in waste if activated inappropriately. The Assessment of Blood Consumption (ABC) score has become a widely accepted score for MTP activation. In this study we compare the use of ABC criteria to physician judgment in MTP activation. METHODS Adult trauma patients treated at University of Louisville Trauma Center from January 2016 to December 2016 were studied. Activation via ABC score was assessed retrospectively from ED data. Location, timing of activation, percent of patients using more than five units of pRBC, amount of product waste, factors associated with early activation by physicians and mortality were analyzed. RESULTS 3,421 patients were included in this study. Only 33% of the patients who would have had MTP activation based on the ABC criteria used more than 5 units of blood products within 24 hours of admission compared to 65% of the patients in whom clinical judgment was used. 76% of all MTP activations from clinical judgment would have been activated by the ABC criteria in the ED. 55% of all MTP activations via clinical judgment were activated in the OR and 41% in the ED. 81% of activations that occurred in the OR by physician judgment could have been activated earlier in the ED if the ABC criteria had been used. However, ABC score can lead to higher potential FFP waste (588u vs 84u) compared to physician judgement. CONCLUSION ABC criteria overestimates need for MT and can lead to increased product waste compared to physician judgement, but its use leads to earlier MTP activation. Criteria to trigger MT activation should rely on both clinical acumen and validated prediction tools. Study type Diagnostic test Level of Evidence Level 3 Correspondence: Amirreza Motameni MD, Department of Surgery, University of Louisville, Email: amirm1231@gmail.com, 550 South Jackson Street, Louisville, KY 40202 There are no conflicts of interest for any of the above-mentioned authors, this incudes pharmaceutical and/or industry support. No funding was received for this work. This work was presented at 31st Annual Meeting of the Eastern Association for the Surgery of Trauma, January 9-13, 2018 in Lake Buena Vista, Florida. Electronically Signed: Amirreza Motameni MD © 2018 Lippincott Williams & Wilkins, Inc.

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