ABC Score for Massive Transfusion
Trauma patients for whom massive transfusion is being considered.
- Does not require laboratory results or complex calculations.
- The FAST exam used to determine the score relies on the skill level of the person performing and interpreting the study.
- The score tends to overtriage in favor of receiving massive transfusion, ensuring a low chance of withholding massive transfusion from a patient that needs it.
- While the score can help aid the decision to initiate massive transfusion, the lead physician(s) managing the trauma should place the order, as a massive transfusion can quickly stretch the limits of the hospital blood supply.
Early initiation of massive transfusion has been shown to improve survival in critical trauma patients. The ABC Score reduces delay in determining need for massive transfusion in a trauma patient, while also providing consistency in appropriateness of transfusion by reducing practice variations among providers.
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From the Creator
What recommendations do you have for doctors once they have applied the ABC Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?
Once adopted or incorporated into a prehospital or ED massive transfusion protocol, one can evaluate for impact on
What we have done is look at predicting those who receive one cooler of products (6 RBCs, 6 plasma, "6-pack" platelets), rather than 10 units of RBCs. At the end of the day, it's about having the products your patient needs at the bedside when you need them and not waiting for them. You can always send the products back if you don't end up needing/using them (and should in an expeditious manner).
Why did you develop the ABC Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?
We developed the ABC Score to help to remind physicians to activate their massive transfusion protocol (MTP) quicker. We saw at our hospital that delays in activation (activating it as little as 10-15 later) were associated with an almost 3-fold increase in mortality. More recently, we have shown that every minute (every 60 seconds!) delay in activating your MTP after patient arrival is associated with a 5% increase likelihood of mortality, as is every minute delay in receiving the coolers once activated.
What pearls, pitfalls and/or tips do you have for users of the ABC Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?
The biggest pitfall or inappropriate use is in settings where your ED/trauma team does not use FAST/ultrasound (or isn't very facile with FAST). In the initial development dataset and in subsequent validation datasets, the most powerful predictor of the four individual components was positive FAST. So, if you are going to use the ABC, you should be doing FAST on every patient (and doing them well).
In a multi-center validation study, the ABC Score demonstrated a negative predictive value of over 95%, meaning that the score missed less than 5% of patients who ultimately received a massive transfusion. So, it will get products to the bedside when you need them (even though you may not end up using them all), but will only miss bringing the products to the bedside in a small number of cases.
When looking at your program and seeing that not all patients predicted are getting to 10 units of RBCs shouldn't be viewed as a failure. The question is, is did they get/need multiple products in a short time frame after being predicted to need them? Also, if you are seeing true product waste (rather than blood bank tech time and MTP cooler "runner" time wastage), then one should look at your product handling and timely return of products. You should always be able to send products back in a timely fashion in patients that do not end up needing all or even some of the products.
Any other research in the pipeline that you're particularly excited about?
We have recently shown that a prehospital ABC Score is just as powerful at predicting not only need for
How do you use the ABC Score in your own clinical practice? Can you give an example of a scenario in which you use it?
Not only have we used it as an entry
About the Creator
Bryan Cotton, MD, MPH, is a professor in the department of surgery, division of acute care surgery at the University of Texas Health Center in Houston. He is an active researcher in the field of trauma and traumatic injury.
To view Dr. Bryan Cotton's publications, visit PubMed