Modified traumatic bleeding severity score: early determination of the need for massive transfusion

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Determination of the need for massive transfusion (MT) is essential for early activation of a MT protocol. The Traumatic Bleeding Severity Score (TBSS) predicts the need for MT accurately, but takes time to determine because systolic blood pressure after a 1000 mL of crystalloid infusion is used. The aim of this study is to determine the how well the Modified TBSS (age, sonography, pelvic fracture, serum lactate and systolic blood pressure on arrival) predicts the need for MT (accuracy).


This is a single-center retrospective study of trauma patients (Injury Severity Score ≧ 16) admitted between 2010 and 2014. The TBSS, the Trauma Associated Severe Hemorrhage (TASH) Score, and the Modified TBSS were calculated. MT is defined as ≧ 10 U packed red blood cell transfusion within 24 hours of injury, and the predictive value of the need for MT was compared by area under the receiver operating characteristic curve (AUC) analysis among three scores.


Three hundred patients were enrolled, and MT given to 25% of patients. Although the AUC of the TBSS was higher than that of the TASH score (0.956 vs 0.912, P = .006) and the Modified TBSS (0.956 vs 0.915, P = .001), there was no difference between the AUC of the Modified TBSS and the TASH score. The Modified TBSS has high accuracy, within an AUC > 0.9.


The predictive value of the Modified TBSS of the need for MT is still high and is equivalent to the TASH score. The Modified TBSS is calculated earlier in resuscitation than the original TBSS.

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