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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

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

Authors: Sophie Rym Hamada, Anne Rosa, Tobias Gauss, Jean-Philippe Desclefs, Mathieu Raux, Anatole Harrois, Arnaud Follin, Fabrice Cook, Mathieu Boutonnet, 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, the Traumabase® Group

Published in: Critical Care | Issue 1/2018

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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.
Appendix
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Metadata
Title
Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma
Authors
Sophie Rym Hamada
Anne Rosa
Tobias Gauss
Jean-Philippe Desclefs
Mathieu Raux
Anatole Harrois
Arnaud Follin
Fabrice Cook
Mathieu Boutonnet
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
the Traumabase® Group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2026-9

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