J Korean Med Sci.
2019 Dec;34(50):e318. 10.3346/jkms.2019.34.e318.
Prognostic Accuracy of Massive Transfusion, Critical Administration Threshold, and Resuscitation Intensity in Assessing Mortality in Traumatic Patients with Severe Hemorrhage: a Meta-Analysis
- Affiliations
-
- 1Department of Trauma Surgery, Wonkwang University Hospital, Iksan, Korea. wkafyddl@hanmail.net
- 2College of Education, Jeonju University, Jeonju, Korea.
- 3Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea. anapyojs@gmail.com
- 4Trauma Center, Wonkwang University Hospital, Iksan, Korea.
- KMID: 2466274
- DOI: http://doi.org/10.3346/jkms.2019.34.e318
Abstract
- BACKGROUND
The aim of this study was to assess the prognostic value of massive transfusion (MT), critical administration threshold (CAT), and resuscitation intensity (RI) for the mortality of trauma patients with severe hemorrhage.
METHODS
Seventeen relevant articles were obtained by searching the PubMed databases through February 15, 2019. The estimated mortality rates and injury severity scores were obtained through a meta-analysis. In addition, diagnostic test accuracy (DTA) reviews were conducted to obtain the sensitivity, specificity, diagnostic odds ratio, and the summary receiver operating characteristic curve.
RESULTS
At 24 hours, the estimated mortality rates were 0.194, 0.126, and 0.168 in assessments using MT, CAT, and RI, respectively. In addition, the pooled sensitivity of CAT (0.89; 95% confidence interval [CI], 0.82-0.94) was significantly higher than that of MT (0.63; 95% CI, 0.57-0.68) and RI (0.69; 95% CI, 0.63-0.75). Overall, the pooled specificity of MT and CAT was 0.82 (95% CI, 0.80-0.83) and 0.85 (95% CI, 0.83-0.88), respectively, while the pooled sensitivity was 0.49 (95% CI, 0.44-0.54) and 0.50 (95% CI, 0.38-0.62), respectively.
CONCLUSION
CAT may be a more sensitive predictor for 24-hour mortality than other predictors. Furthermore, RI also appears to be a useful predictor for 24-hour mortality. Both MT and CAT showed high specificity for overall mortality.
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