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Emergency medicine
Research
Prognostic model for traumatic death due to bleeding: cross-sectional international study
  1. Francois-Xavier Ageron1,2,
  2. Angele Gayet-Ageron1,3,
  3. Ewout Steyerberg4,5,
  4. Pierre Bouzat6,
  5. Ian Roberts1
  1. 1 Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Emergency Department and Northern French Alps Emergency Network, Hospital Annecy Genevois, Annecy, France
  3. 3 Clinical Research Center and Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospital Geneva, Geneva, Switzerland
  4. 4 Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Rotterdam, The Netherlands
  5. 5 Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  6. 6 Grenoble Alpes Trauma Center, Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
  1. Correspondence to Francois-Xavier Ageron; fxageron{at}gmail.com

Abstract

Objective To develop and validate a prognostic model and a simple model to predict death due to bleeding in trauma patients.

Design Cross-sectional study with multivariable logistic regression using data from two large trauma cohorts.

Setting 274 hospitals from 40 countries in the Clinical Randomisation of Anti-fibrinolytic in Significant Haemorrhage (CRASH-2) trial and 24 hospitals in the Northern French Alps Trauma registry.

Participants 13 485 trauma patients in the CRASH-2 trial and 9945 patients in the Northern French Alps Trauma registry who were admitted to hospital within 3 hours of injury.

Main outcome measure In-hospital death due to bleeding within 28 days.

Results There were 815 (6%) deaths from bleeding in the CRASH-2 trial and 102 (1%) in the Northern French Alps Trauma registry. The full model included age, systolic blood pressure (SBP), Glasgow Coma Scale (GCS), heart rate, respiratory rate and type of injury (penetrating). The simple model included age, SBP and GCS. In a cross-validation procedure by country, discrimination and calibration were adequate (pooled C-statistic 0.85 (95% CI 0.81 to 0.88) for the full model and 0.84 (95% CI 0.80 to 0.88) for the simple model).

Conclusion This prognostic model can identify trauma patients at risk of death due to bleeding in a wide range of settings and can support prehospital triage and trauma audit, including audit of tranexamic acid use.

  • trauma
  • injury
  • bleeding
  • haemorrhage
  • prognostic
  • coagulopathy
  • death
  • score
  • audit
  • human

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-026823

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    Footnotes

    • Contributors FXA, IR designed the study. FXA, PB, IR designed and monitored the data collection from which this paper was developed. FXA, AGA analysed the data. PB gave feedback about the clinical use. ES gave feedback and statistical advice. FXA, IR wrote the first draft. FXA, AGA, ES, PB, IR contributed to write and revised the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The CRASH-2 trial received ethics committee approval from the London School of Hygiene & Tropical Medicine, UK and the ethics committees of all participating hospitals. The Northern French Alps Trauma Registry was approved by the ethics committee of the university hospital of Clermont-Ferrand, France.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data from the CRASH-2 trial is available via freeBIRD (free bank of injury and emergency research data), hosted by the Clinical Trial Unit of the London School of Hygiene and Tropical Medicine. More information at .

    • Patient consent for publication Not required.