TASH (Trauma-Associated Severe Hemorrhage) is another scoring system (J. Trauma 2006;60:1228–36). “At the present time, one of several validated scoring systems – ABC, TASH – will rapidly identify those who require massive transfusion with an over-triage rate [positive predictive value] of about 50% and under-triage rate [negative predictive value] of about 5%,” said Dr. Cotton, who is on the surgery faculty in the division of acute care surgery at the University of Texas at Houston.
Another concern with MTPs is knowing when to call off the protocol. “You have to get a feel for when to stop, because if you forget to call [your blood bank], they are going to continue making products,” Dr. Dente said. “Once you get bleeding control as the operating surgeon, you have to communicate that. If you don't … you have the potential to actually waste products or to give products unnecessarily.”
Dr. Dente and his colleagues reviewed their MTP use at Grady Memorial and found a 27% overtriage rate, which meant that the protocol was activated for more than one-quarter of patients who never received a massive transfusion (J. Trauma 2010;68:298–304).
Overall resource use does not change significantly, but the timing does. “The goal of an MTP is to change the amount of transfusions on the back end,” Dr. Dente said.
Dr. Dente and Dr. Kashuk said they have no relevant financial disclosures. Dr. Cotton said he recently received a grant from Haemonetics Corp. (makers of a TEG system) for an investigator-initiated, multicenter study evaluating the ability of rapid TEG to describe coagulopathy in severely injured patients.
Dr. Christopher Dente supports the use of MTP in his hospital.
Source Courtesy Dr. Jamie Jones