Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma
Abstract Background Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt tr...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2026-9 |
| _version_ | 1818330414171815936 |
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| author | Sophie Rym Hamada Anne Rosa Tobias Gauss Jean-Philippe Desclefs Mathieu Raux Anatole Harrois Arnaud Follin Fabrice Cook Mathieu Boutonnet the Traumabase® Group Arie Attias Sylvain Ausset Gilles Dhonneur Olivier Langeron Catherine Paugam-Burtz Romain Pirracchio Bruno Riou Guillaume de St Maurice Bernard Vigué Alexandra Rouquette Jacques Duranteau |
| author_facet | Sophie Rym Hamada Anne Rosa Tobias Gauss Jean-Philippe Desclefs Mathieu Raux Anatole Harrois Arnaud Follin Fabrice Cook Mathieu Boutonnet the Traumabase® Group Arie Attias Sylvain Ausset Gilles Dhonneur Olivier Langeron Catherine Paugam-Burtz Romain Pirracchio Bruno Riou Guillaume de St Maurice Bernard Vigué Alexandra Rouquette Jacques Duranteau |
| author_sort | Sophie Rym Hamada |
| collection | DOAJ |
| description | Abstract Background Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures. Methods A multicentre retrospective study of prospectively collected data from a trauma registry (Traumabase®) was performed. SH was defined as: packed red blood cell (RBC) transfusion in the trauma room, or transfusion ≥ 4 RBC in the first 6 h, or lactate ≥ 5 mmol/L, or immediate haemostatic surgery, or interventional radiology and/or death of haemorrhagic shock. Pre-hospital characteristics were selected using a multiple logistic regression model in a derivation cohort to develop a Red Flag binary alert whose performances were confirmed in a validation cohort. Results Among the 3675 patients of the derivation cohort, 672 (18%) had SH. The final prediction model included five pre-hospital variables: Shock Index ≥ 1, mean arterial blood pressure ≤ 70 mmHg, point of care haemoglobin ≤ 13 g/dl, unstable pelvis and pre-hospital intubation. The Red Flag alert was triggered by the presence of any combination of at least two criteria. Its predictive performances were sensitivity 75% (72–79%), specificity 79% (77–80%) and area under the receiver operating characteristic curve 0.83 (0.81–0.84) in the derivation cohort, and were not significantly different in the independent validation cohort of 2999 patients. Conclusion The Red Flag alert developed and validated in this study has high performance to accurately predict or exclude SH. |
| first_indexed | 2024-12-13T13:03:34Z |
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| id | doaj.art-8b899d442d65438793c796bb733a63a3 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-13T13:03:34Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
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| series | Critical Care |
| spelling | doaj.art-8b899d442d65438793c796bb733a63a32022-12-21T23:44:54ZengBMCCritical Care1364-85352018-05-0122111210.1186/s13054-018-2026-9Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt traumaSophie Rym Hamada0Anne Rosa1Tobias Gauss2Jean-Philippe Desclefs3Mathieu Raux4Anatole Harrois5Arnaud Follin6Fabrice Cook7Mathieu Boutonnet8the Traumabase® GroupArie AttiasSylvain AussetGilles DhonneurOlivier LangeronCatherine Paugam-BurtzRomain PirracchioBruno RiouGuillaume de St MauriceBernard ViguéAlexandra Rouquette9Jacques Duranteau10Université Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris SudUniversité Paris Sud, Department of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris (AP-HP), Béclère Hôpitaux Universitaires Paris SudHôpitaux Universitaires Paris Nord Val de Seine, Department of Anesthesiology and Critical Care, AP-HP, BeaujonCentre Hospitalier Sud-Francilien, SAMU 91 Emergency DepartmentSorbonne Université and Department of Anesthesiology and Critical Care, AP-HP, Hôpitaux Universitaires Pitié-SalpêtrièreUniversité Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris SudUniversité Paris Descartes, Department of Anesthesiology and Critical Care, AP-HP, Hôpital Européen Georges Pompidou—Hôpitaux Universitaires Paris OuestUniversité Paris Est, Department of Anesthesiology and Critical Care, APHP, Hôpital Henri MondorDepartment of Anesthesiology and Critical Care, Percy Military Teaching HospitalCESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, ParisUniversité Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris SudAbstract Background Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures. Methods A multicentre retrospective study of prospectively collected data from a trauma registry (Traumabase®) was performed. SH was defined as: packed red blood cell (RBC) transfusion in the trauma room, or transfusion ≥ 4 RBC in the first 6 h, or lactate ≥ 5 mmol/L, or immediate haemostatic surgery, or interventional radiology and/or death of haemorrhagic shock. Pre-hospital characteristics were selected using a multiple logistic regression model in a derivation cohort to develop a Red Flag binary alert whose performances were confirmed in a validation cohort. Results Among the 3675 patients of the derivation cohort, 672 (18%) had SH. The final prediction model included five pre-hospital variables: Shock Index ≥ 1, mean arterial blood pressure ≤ 70 mmHg, point of care haemoglobin ≤ 13 g/dl, unstable pelvis and pre-hospital intubation. The Red Flag alert was triggered by the presence of any combination of at least two criteria. Its predictive performances were sensitivity 75% (72–79%), specificity 79% (77–80%) and area under the receiver operating characteristic curve 0.83 (0.81–0.84) in the derivation cohort, and were not significantly different in the independent validation cohort of 2999 patients. Conclusion The Red Flag alert developed and validated in this study has high performance to accurately predict or exclude SH.http://link.springer.com/article/10.1186/s13054-018-2026-9Severe traumaSevere haemorrhageProtocolOrganizationAnticipation |
| spellingShingle | Sophie Rym Hamada Anne Rosa Tobias Gauss Jean-Philippe Desclefs Mathieu Raux Anatole Harrois Arnaud Follin Fabrice Cook Mathieu Boutonnet the Traumabase® Group Arie Attias Sylvain Ausset Gilles Dhonneur Olivier Langeron Catherine Paugam-Burtz Romain Pirracchio Bruno Riou Guillaume de St Maurice Bernard Vigué Alexandra Rouquette Jacques Duranteau Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma Critical Care Severe trauma Severe haemorrhage Protocol Organization Anticipation |
| title | Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma |
| title_full | Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma |
| title_fullStr | Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma |
| title_full_unstemmed | Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma |
| title_short | Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma |
| title_sort | development and validation of a pre hospital red flag alert for activation of intra hospital haemorrhage control response in blunt trauma |
| topic | Severe trauma Severe haemorrhage Protocol Organization Anticipation |
| url | http://link.springer.com/article/10.1186/s13054-018-2026-9 |
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