Prognostic model for traumatic death due to bleeding: cross-sectional international study

BMJ Open. 2019 May 28;9(5):e026823. doi: 10.1136/bmjopen-2018-026823.


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.

Keywords: audit; bleeding; coagulopathy; death; haemorrhage; human; injury; prognostic; score; trauma.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Hemorrhage / etiology
  • Hemorrhage / mortality*
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Models, Theoretical*
  • Prognosis
  • Registries / statistics & numerical data
  • Reproducibility of Results
  • Wounds and Injuries / complications
  • Wounds and Injuries / mortality*
  • Young Adult