Accuracy of emergency transfusion score in prediction need for blood transfusion among multiple trauma patients: A cross-sectional study from Iran.

OBJECTIVE: Prediction of blood transfusion requirement in trauma patients is a dilemma in most trauma centers. The aim of the current study was assessing the accuracy of emergency transfusion score (ETS) in detecting patients' need for blood transfusion in ED. METHODS: In this cross-sectional study, all multiple trauma patients referred to the emergency department (ED) of Imam Hossein Hospital, Tehran, Iran, from March to August 2014, were enrolled. ETS parameters including low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism were recorded for all patients. ETS was calculated for all patients and compared with patients who received blood transfusion to estimate the accuracy of ETS. RESULTS: Of the 793 patients included in the study, 54 (6%) received blood in the ED. The mean of ETS for all patients was 3.91 ± 0.93. There was a significant correlation between ETS more than 3 and amount of blood transfusion (P = 0.004). The sensitivity, specificity, positive, and negative predictive value of ETS was 98.1%, 13.8%, 7.7%, and 99%, respectively. CONCLUSION: ETS may be considered as a useful instrument for prioritizing multiple trauma patients' need for blood transfusion in Iran. Therefore, by implementing this score, it may be prevented from inappropriate requests for blood transfusion.

Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake.

INTRODUCTION. Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury (AKI), by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. MATERIALS AND METHODS. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. RESULTS. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI (35.0%). There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. CONCLUSIONS. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake.