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

Abstract 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 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.