Massive transfusion triggers in severe trauma: Scoping review.
Cristina Estebaranz-Santamaría, Ana María Palmar-Santos, Azucena Pedraz-Marcos
PMID 30517587WHAT IT FOUND
No universal massive transfusion trigger scale exists for severe trauma.
Scales varied by setting and definition, and several vital signs, labs and injury features were reported as predictors, but none can be recommended as a single standard.
Key findings
01No consensus exists on the clinical, physiological or anatomical triggers that should initiate massive transfusion in severe trauma.
02Among the scales reviewed, TBSS, TASH and ABC had the highest reported values for predicting massive transfusion.
03Individual triggers reported include low haemoglobin, low systolic blood pressure, positive FAST, elevated INR and base excess, but thresholds were not consistent.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It is a scoping review, not a pooled analysis, so it does not provide a single accuracy estimate for any scale. Most scale studies were retrospective and done in emergency or combat hospitals, so they may not transfer to every trauma setting. Included studies used different definitions of massive transfusion, including different unit counts and time windows. Many studies reported actual use of massive transfusion rather than true need, making it difficult to separate protocol-driven transfusion from clinical necessity. There was no consensus on thresholds for individual triggers such as haemoglobin.
The easy way to misread this
Do not conclude that any listed scale can be used as a universal trigger for massive transfusion. The review found no consensus, and the scales were developed and validated in different settings with different definitions.