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Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool.

Publication ,  Journal Article
Dente, CJ; Mina, MJ; Morse, BC; Hensman, H; Schobel, S; Gelbard, RB; Belard, A; Buchman, TG; Kirk, AD; Elster, EA
Published in: Surgery
November 2021

BACKGROUND: Improper or delayed activation of a massive transfusion protocol may have consequences to individuals and institutions. We designed a complex predictive algorithm that was packaged within a smartphone application. We hypothesized it would accurately assess the need for massive transfusion protocol activation and assist clinicians in that decision. METHODS: We prospectively enrolled patients at an urban, level I trauma center. The application recorded the surgeon's initial opinion for activation and then prompted inputs for the model. The application provided a prediction and recorded the surgeon's final decision on activation. RESULTS: Three hundred and twenty-one patients were enrolled (83% male; 59% penetrating; median Injury Severity Score 9; mean base deficit -4.11). Of 36 massive transfusion protocol activations, 26 had an app prediction of "high" or "moderate" probability. Of these, 4 (15%) patients received <10 u blood as a result of early hemorrhage control. Two hundred and eighty-five patients did not have massive transfusion protocol activated by the surgeon with 27 (9%) patients having "moderate" or "high" likelihood predicted by the application. Twenty-four of these did not require massive transfusion, and all patients had acidosis that unrelated to hemorrhagic shock. For 13 (50%) of the patients with "high" probability, the surgeon correctly altered their initial decision based on this information. The algorithm demonstrated an adjusted accuracy of 0.96 (95% confidence interval [0.93-0.98); P ≤ .001]), sensitivity = 0.99, specificity 0.72, positive predictive value 0.96, negative predictive value 0.99, and area under the receiver operating curve = 0.86. CONCLUSION: A smartphone-based clinical decision tools can aid surgeons in the decision to active massive transfusion protocol in real time, although it does not completely replace clinician judgment.

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Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

November 2021

Volume

170

Issue

5

Start / End Page

1574 / 1580

Location

United States

Related Subject Headings

  • Surgery
  • Smartphone
  • Shock, Hemorrhagic
  • Prospective Studies
  • Mobile Applications
  • Male
  • Humans
  • Female
  • Decision Support Systems, Clinical
  • Blood Transfusion
 

Citation

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Dente, C. J., Mina, M. J., Morse, B. C., Hensman, H., Schobel, S., Gelbard, R. B., … Elster, E. A. (2021). Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool. Surgery, 170(5), 1574–1580. https://doi.org/10.1016/j.surg.2021.04.034
Dente, Christopher J., Michael J. Mina, Bryan C. Morse, Hannah Hensman, Seth Schobel, Rondi B. Gelbard, Arnaud Belard, Timothy G. Buchman, Allan D. Kirk, and Eric A. Elster. “Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool.Surgery 170, no. 5 (November 2021): 1574–80. https://doi.org/10.1016/j.surg.2021.04.034.
Dente CJ, Mina MJ, Morse BC, Hensman H, Schobel S, Gelbard RB, et al. Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool. Surgery. 2021 Nov;170(5):1574–80.
Dente, Christopher J., et al. “Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool.Surgery, vol. 170, no. 5, Nov. 2021, pp. 1574–80. Pubmed, doi:10.1016/j.surg.2021.04.034.
Dente CJ, Mina MJ, Morse BC, Hensman H, Schobel S, Gelbard RB, Belard A, Buchman TG, Kirk AD, Elster EA. Predicting the need for massive transfusion: Prospective validation of a smartphone-based clinical decision support tool. Surgery. 2021 Nov;170(5):1574–1580.
Journal cover image

Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

November 2021

Volume

170

Issue

5

Start / End Page

1574 / 1580

Location

United States

Related Subject Headings

  • Surgery
  • Smartphone
  • Shock, Hemorrhagic
  • Prospective Studies
  • Mobile Applications
  • Male
  • Humans
  • Female
  • Decision Support Systems, Clinical
  • Blood Transfusion