What is the assessment of the Blood Consumption Scoring (BCS) system?

From the Guidelines

The Assessment of Blood Consumption scoring system is not directly addressed in the provided evidence, however, the ISTH BAT score is a relevant tool used for assessing bleeding phenotypes, with 80% of experts using it as a standardized approach. The ISTH BAT score evaluates bleeding symptoms and assigns a score, with normal reference ranges established for different age groups and sexes 1. In the context of bleeding disorders of unknown cause (BDUC), the ISTH BAT score is used to assess and objectively document bleeding symptoms, rather than relying solely on it for ordering further blood testing 1. Key considerations in the assessment of BDUC patients include a positive family history, exclusion of aspirin and nonsteroidal anti-inflammatory drug use, and evaluation for hypermobility and iron deficiency 1. The use of tranexamic acid (TXA) is a common approach in managing heavy menstrual bleeding in women with BDUC, with 57% of respondents adding TXA to combined oral contraceptive pills (COCP) when bleeding persists 1. In terms of prophylaxis for surgical procedures in BDUC patients, TXA is a prominent feature, accounting for 72% of responses for minor procedures, 59% for major, and 58% of deliveries 1. The evidence highlights the importance of a standardized approach to assessing bleeding phenotypes and managing BDUC patients, with a focus on minimizing unnecessary blood testing and transfusions 1. Overall, the assessment of blood consumption scoring system is not directly addressed, but the ISTH BAT score and other tools play a crucial role in evaluating bleeding phenotypes and guiding management decisions in BDUC patients. Some studies suggest that restrictive blood transfusion practices, guided by clinical decision support systems, can improve patient outcomes and reduce blood utilization 1. However, the evidence provided does not directly link these practices to the assessment of blood consumption scoring system. In clinical practice, the focus should be on using standardized tools, such as the ISTH BAT score, to assess bleeding phenotypes and guide management decisions, while also considering the importance of minimizing unnecessary blood testing and transfusions. The use of TXA and other therapies should be guided by evidence-based recommendations and individual patient needs. Ultimately, the goal is to improve patient outcomes, reduce morbidity and mortality, and enhance quality of life for individuals with bleeding disorders.

From the Research

Assessment of Blood Consumption Scoring System

The Assessment of Blood Consumption (ABC) score is a scoring system used to predict which severely injured trauma patients will require massive transfusion.

• The ABC score has been shown to be a useful tool in identifying patients who will require massive transfusion, with a sensitivity of 51% and a specificity of 85% in the prehospital setting 2.
• The score can be calculated using prehospital data, including heart rate, systolic blood pressure, and focused assessment with sonography for trauma (FAST) exam results 2, 3.
• The ABC score has been validated in various studies, including a retrospective analysis of 2,067 patients, which found that the score was 60% sensitive and 84% specific for predicting massive transfusion 2.
• The use of the ABC score has been shown to lead to earlier activation of massive transfusion protocols (MTPs) and improved outcomes, including reduced mortality 4, 5.
• However, the ABC score can also lead to increased product waste if not used in conjunction with clinical judgment 4.
• Some studies have suggested that combining the ABC score with other parameters, such as blood lactate level, may improve its predictive value for massive transfusion requirement 6.

Predictive Value

The predictive value of the ABC score has been evaluated in several studies, with varying results.

• One study found that the ABC score had a positive predictive value of 48% and a negative predictive value of 95% for predicting emergent laparotomy 3.
• Another study found that the ABC score had a positive predictive value of 28% and a negative predictive value of 94% for predicting massive transfusion 3.
• The area under the receiver operating characteristic (AUROC) curve for the ABC score has been reported to be between 0.73 and 0.81, indicating moderate to good predictive value 2, 3.

Clinical Application

The ABC score has been implemented in various clinical settings, including prehospital and emergency department settings.

• One study found that the use of the ABC score in the prehospital setting led to a 23% decrease in mortality 5.
• Another study found that the use of the ABC score in the emergency department led to earlier activation of MTPs and improved outcomes 4.
• The ABC score has been shown to be a useful tool in identifying patients who will require massive transfusion, and its use can help guide clinical decision-making and improve patient outcomes 4, 2, 3, 6, 5.