The Traumatic Bleeding Severity Score Predicts Need for Massive Transfusion

Richard D. Zane, MD, FAAEM

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.

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 (see table); 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 >15 for predicting the need for massive transfusion were 97.4% and 96.2%, respectively.

Citation(s):

Ogura T et al. Predicting the need for massive transfusion in trauma patients: The Traumatic Bleeding Severity Score. J Trauma Acute Care Surg 2014 May; 76:1243.