TAMING THE SRU - December 31, 2019 - By Colleen Laurence
"We are now approaching 10 years since Nunez and colleagues first shared the ABC Score. In the seeming flood of comparative studies that followed, the ABC Score has been variable in its predictive value, never performing quite as well as it did in Nunez and Cotton’s studies. It is only right then that it continues to be reassessed as new scores are validated and point-of-care testing evolves. Ultimately though, there the American College of Surgeons continues to recommend its adoption above other tools to trigger MTP. Why?
The ABC Score is easy to remember and to use – four simple variables without weights attached.
The ABC Score does not rely on time-consuming tests. In general, scores that incorporate more sophisticated variables and weighting unsurprisingly demonstrated superior predictive value compared to the ABC Score. However, they relied on laboratory or radiographic analysis, which could critically delay transfusion.
Finally, while the ABC Score overestimates the need for massive transfusion, it also consistently identifies those patients who will require a massive transfusion. It is important to remember that these scores are not predicting who will need transfusion, only who will need the additional resources of Massive Transfusion. Ultimately over-triaging is an unfortunate, but acceptable consequence in exchange for a patient who can be appropriately resuscitated and survive."