الفهرس 
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Abstract
It is a well-known fact that trauma is a worldwide problem and a main cause of morbidity and mortality universally. Trauma is the leading cause of mortality in the first four decades of life. Early death post trauma is attributed mostly to massive and ongoing bleeding. Hemorrhage is the commonest potentially preventable cause of early death post trauma. Early definitive surgery to control bleeding and early recognition of patients at risk of massive transfusion help in correction of lethal triad that includes coagulopathy, acidosis and hypothermia and associated with increased mortality.
About 40% of trauma-related mortality is due to uncontrolled bleeding so restoration of intravascular volume is the first priority in resuscitation. The goal of resuscitation is to restore organ perfusion and tissue oxygenation, which is accomplished with administering crystalloid solution and blood products to replace lost intravascular volume.
MBT refers to the transfusion of large volume of blood products over a short period of time to a patient who has severe or uncontrolled haemorrhage.
Common definitions of MBT in adult patients are transfusion of ≥10 red blood cell (RBC) units, which approximates the total blood volume (TBV) of an average adult patient, within 24 h, transfusion of 4 RBC units in 1 h with anticipation of continued need for blood product support, or replacement of 50% of the TBV by blood products within 3 h.
The main purpose of blood transfusion is to restore the oxygen-carrying capacity of the intravascular volume. Fully cross matched pRBCs are preferable for this purpose, but the complete cross matching process requires approximately 1 hour in most blood banks. For patients who stabilize rapidly, crossmatched pRBCs should be obtained and made available for transfusion when indicated. If crossmatched blood is unavailable, type O pRBCs are indicated for patients with exsanguinating hemorrhage.
MTPs describe an empirical treatment that optimizes management of resuscitation and correction of coagulopathy arising from severe haemorrhage.
For early prediction of the potential need for MBT post trauma numerous prediction models were developed and gradually increasing over time. Since 2011, 19 models were published.
Prince of Wales Hospital Trauma registry in Hong Kong developed PWH score which contains 7 variables measured to give score (PWH score). The PWH score is a 10-point prediction rule for determining the increased likelihood of need for MBT. In the study developing the score, seven variables, easily measured or identified in the trauma resuscitation room, were identified. The variables were systolic blood pressure, Glasgow Coma score, heart rate, displaced pelvic fractures, a positive FAST or computerized tomography scan, base deficit and haemoghlobin.
This study aims to assess the performance of PWH and as a tool for prediction of MBT in poly traumatized patients.
This study was conducted on sixty one (61) patients presented to ED with polytrauma of Menoufia University Hospital from September 2017 to September 2018.
All patients selected according to inclusion and exclusion criteria. All patients were evaluated and resuscitated in the Emergency Unit by emergency physicians. Evaluation included primary survey, secondary survey, laboratory investigations, imaging, and calculation of PWH.
The result of this study showed that:
The age of the patients ranged from (19 – 75). The main mechanism of trauma was blunt trauma that represented 56 (91.8%) patient. The main mode of trauma was road traffic accidents (RTA) that represented 44 (72.1%) followed by falling from height that represented 12 (19.7%) and violence that represented 5 (8.2%) of cases.
The mean heart rate was higher in cases receiving MBT (134.24±10.73).
The mean injury severity score was higher in these cases receiving MBT. The mean systolic blood pressure was lower in cases receiving MBT. Those three variables showed significant relation with predicting MBT.
Relation between glascow coma scale (GCS) and prediction of MBT was not significant.
Mean hemoglobin level was lower in cases receiving MBT. The mean of base deficit was higher in cases receiving MBT. Both hemoglobin level and base deficit showed significant relation with predicting MBT.
Unstable pelvic fracture was noted in 8 of cases receiving MBT and showed significant relation with MBT.
This study showed also that:
For PWH score the best cut off point was 4.5 with a sensitivity of 100%, Specificity of 80%, PPV was72.4%, NPV was 100%, accuracy was 86.9% in predicting MBT. Area under ROC for PWH score was 0.92.
The results of this study were discussed and compared with other studies.