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Crit Care. 2018 May 5;22(1):113. doi: 10.1186/s13054-018-2026-9.

Development and validation of a pre-hospital "Red Flag" alert for activation of intra-hospital haemorrhage control response in blunt trauma.

Author information

1
Université Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, F-94275, Le Kremlin Bicêtre, France. sophiehamada@hotmail.com.
2
CESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, Paris, CESP, INSERM, Maison de Solenn, 97 boulevard de Port-Royal, 75014, Paris, France. sophiehamada@hotmail.com.
3
Université Paris Sud, Department of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris (AP-HP), Béclère Hôpitaux Universitaires Paris Sud, 157 rue de la porte de Trivaux, 92140, Clamart, France.
4
Hôpitaux Universitaires Paris Nord Val de Seine, Department of Anesthesiology and Critical Care, AP-HP, Beaujon, 100 avenue du Général Leclerc, 92110, Clichy, France.
5
Centre Hospitalier Sud-Francilien, SAMU 91 Emergency Department, 40 avenue Serge Dassault, 91100, Corbeil-Essonnes, France.
6
Sorbonne Université and Department of Anesthesiology and Critical Care, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
7
Université Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, F-94275, Le Kremlin Bicêtre, France.
8
Université Paris Descartes, Department of Anesthesiology and Critical Care, AP-HP, Hôpital Européen Georges Pompidou-Hôpitaux Universitaires Paris Ouest, 20 rue Leblanc, 75015, Paris, France.
9
Université Paris Est, Department of Anesthesiology and Critical Care, APHP, Hôpital Henri Mondor, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.
10
Department of Anesthesiology and Critical Care, Percy Military Teaching Hospital, 101 avenue Henri-Barbusse, 92140, Clamart, France.
11
CESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, Paris, CESP, INSERM, Maison de Solenn, 97 boulevard de Port-Royal, 75014, Paris, France.
12
AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, 78 rue du Général Leclerc, F-94275, Le Kremlin Bicêtre, France.

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.

KEYWORDS:

Anticipation; Organization; Protocol; Severe haemorrhage; Severe trauma

PMID:
29728151
PMCID:
PMC5935988
DOI:
10.1186/s13054-018-2026-9
[Indexed for MEDLINE]
Free PMC Article

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