Prehospital transfusion: an 8-year descriptive retrospective monocenter study.

Abstract

Background: Hemorrhagic shock (HS) is a critical prehospital condition. This study aimed to evaluate the predictive value of the Red Flag criteria on scene versus clinical judgment (gestalt) at initial call for massive transfusion (MT). Secondary aims included determining the proportion of prehospital interventions with packed red blood cells (pRBCs) units and to describe the characteristics of patients for whom dispatch physicians decided to send mobile prehospital team with pRBCs.

Methods: A retrospective study in a French tertiary care hospital (2015-2023) analyzed prehospital interventions involving RBCs. MT was defined as the transfusion of ≥ 4 pRBCs or fresh frozen plasma units within 24 h. The data included demographics, clinical parameters, and outcomes. The predictive performance of the gestalt and Red flag criteria was compared via the area under the receiver operating characteristic curve (AUROC).

Results: Among 38,128 interventions, 105 (0.3%) involved 2 pRBCs units transport and 11 (5%) pRBCs units were discarded. Seventy-four (72%) patients were men, median age was 50 (28-67) years old and trauma was the reason for intervention for 67 (65%) patients. A total of 69 (67%) patients received prehospital transfusion: 39 (57%) were trauma patients. The dispatch physician's gestalt score had an AUROC of 0.81, and the Red Flags criteria had an AUCROC of 0.80 in predicting MT within 24 h for trauma patients (p = 0.69).

Conclusion: Gestalt and Red Flag criteria showed similar ability to predict massive transfusion, but gestalt requires experience and lacks reproducibility. Our results advocate for the implementation of standardized decision tools to guide prehospital transfusion practices.

Clinical trial number: Not applicable.