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Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria.

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posted on 2021-02-01, 17:15 authored by Francois-Xavier Ageron, Timothy J Coats, Vincent Darioli, Ian Roberts

Background

Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding.


Methods

We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients.


Results

We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently.


Conclusion

The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

History

Citation

Scand J Trauma Resusc Emerg Med 29, 6 (2021). https://doi.org/10.1186/s13049-020-00827-5

Author affiliation

Department of Health Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

Scandinavian journal of trauma, resuscitation and emergency medicine

Volume

29

Issue

1

Pagination

6

Publisher

Springer Science and Business Media LLC

issn

1757-7241

eissn

1757-7241

Acceptance date

2020-12-15

Copyright date

2021

Available date

2021-01-06

Spatial coverage

England

Language

eng

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