The Traumatic Bleeding Severity Score Predicts Need for Massive Transfusion

Authors: Ogura T et al., J Trauma Acute Care Surg 2014 May 76:1243

The score is simple to calculate and can be done on most smart phones, but needs validation.

Massive-transfusion protocols are designed to avoid coagulopathy by providing guidance for the ratio of blood products used, yet criteria for instituting these protocols are varied or nonexistent.

Traumatic Bleeding Severity Score

These researchers reviewed the records of 199 severely injured patients to identify characteristics associated with the need for massive transfusion, which were then used to develop the Traumatic Bleeding Severity Score (TBSS). Point values for age, systolic blood pressure after rapid infusion of 1 L of crystalloid, number of regions positive on FAST scan, severity of pelvic fracture, and arterial lactate concentration on admission were assigned the sum of the points yields the TBSS.

The TBSS was retrospectively validated in 113 patients. The average score was significantly higher for patients who received massive transfusion than for those who did not (24.2 vs. 6.2). Sensitivity and specificity of a TBSS greater than 15 for predicting the need for massive transfusion were 97.4% and 96.2%, respectively.

Comment

The Traumatic Bleeding Severity Score is easy to calculate and seems promising, but it needs prospective validation. Although not mentioned in this study, readers should familiarize themselves with the role of thromboelastography in managing massive transfusion, as there is robust and growing evidence supporting its use (NEJM JW Emerg Med Jan 24 2014).