ArticleInjury2015
Clinical gestalt and the prediction of massive transfusion after trauma.
Article in Injury, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04431999 (Evaluation of a Transfusion Therapy Using Whole Blood Versus Fractionated Blood Products in the Management of Coagulopathy in Patients Admitted to Hospital for Acute Traumatic Hemorrhage), which is not on this map. Cited by 52 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluation of a Transfusion Therapy Using Whole Blood Versus Fractionated Blood Products in the Management of Coagulopathy in Patients Admitted to Hospital for Acute Traumatic Hemorrhage
Who cites it
52 citing papers in PubMed, 3 syntheses or guidelines pooled it, 129 citations in OpenAlex.
- Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis.Medicina (Kaunas, Lithuania) · 2021Pooled it
- Prognostic Accuracy of Massive Transfusion, Critical Administration Threshold, and Resuscitation Intensity in Assessing Mortality in Traumatic Patients with Severe Hemorrhage: a Meta-Analysis.Journal of Korean medical science · 2019Pooled it
- Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2017Pooled it
- Automatic Detection of Physiological Attributes from Verbal Communication During Time-Critical Medical Events.ACM transactions on computing for healthcare · 2026Article
- Early transfusion strategies in haemorrhagic shock.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- The ethics of blood stewardship and quantitative futility assessments to predict certain death in neurotrauma patients.Frontiers in medicine · 2026Review
- On-scene machine learning prediction model for massive transfusion in trauma and its association with in-hospital mortality.BJS open · 2025Article
- Indicators of early transfusion in paediatric trauma: a retrospective analysis of 11,849 cases from the TraumaRegister DGUScandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- A comparison of clinical prediction scores for massive traumatic hemorrhage.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Factors in the Initial Resuscitation of Patients With Severe Trauma: The FiiRST-2 Randomized Clinical Trial.JAMA network open · 2025Article
- Development of an algorithm for adjudicating actionable hemorrhage in pediatric trauma patients.The journal of trauma and acute care surgery · 2025Article
- Article
- The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients.Journal of clinical medicine · 2025Review
- Utility of point of care viscoelastic haemostatic assays for trauma patients in the emergency department.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Observational
- Development and Validation of a Bayesian Network Predicting Intubation Following Hospital Arrival Among Injured Children.Journal of pediatric surgery · 2025Article
- Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management.Journal of clinical medicine · 2025Review
- Transfusion in trauma: empiric or guided therapy?Research and practice in thrombosis and haemostasis · 2025Article
- Article
- Markers of Futile Resuscitation in Traumatic Hemorrhage: A Review of the Evidence and a Proposal for Futility Time-Outs during Massive Transfusion.Journal of clinical medicine · 2024Review
- A novel scoring system for early prediction of massive transfusion requirement in trauma patients.Internal and emergency medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 3 institutions in 1 country.
Funding
Abstract
introductionEarly recognition and treatment of trauma patients requiring massive transfusion (MT) has been shown to reduce mortality. While many risk factors predicting MT have been demonstrated, there is no universally accepted method or algorithm to identify these patients. We hypothesised that even among experienced trauma surgeons, the clinical gestalt of identifying patients who will require MT is unreliable.
methodsTransfusion and mortality outcomes after trauma were observed at 10 U.S. Level-1 trauma centres in patients who survived ≥ 30 min after admission and received ≥ 1 unit of RBC within 6h of arrival. Subjects who received ≥ 10 units within 24h of admission were classified as MT patients. Trauma surgeons were asked the clinical gestalt question "Is the patient likely to be massively transfused?" 10 min after the patients arrival. The performance of clinical gestalt to predict MT was assessed using chi-square tests and ROC analysis to compare gestalt to previously described scoring systems.
resultsOf the 1245 patients enrolled, 966 met inclusion criteria and 221 (23%) patients received MT. 415 (43%) were predicted to have a MT and 551(57%) were predicted to not have MT. Patients predicted to have MT were younger, more often sustained penetrating trauma, had higher ISS scores, higher heart rates, and lower systolic blood pressures (all p<0.05). Gestalt sensitivity was 65.6% and specificity was 63.8%. PPV and NPV were 34.9% and 86.2% respectively.
conclusionData from this large multicenter trial demonstrates that predicting the need for MT continues to be a challenge. Because of the increased mortality associated with delayed therapy, a more reliable algorithm is needed to identify and treat these severely injured patients earlier.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.