Trauma Associated Severe Hemorrhage (TASH)-Score: Probability of Mass Transfusion as Surrogate for Life Threatening Hemorrhage after Multiple Trauma

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Abstract

Background:

To develop a simple scoring system that allows an early and reliable estimation for the probability of mass transfusion (MT) as a surrogate for life threatening hemorrhage following multiple trauma.

Methods:

Potential clinical and laboratory variables documented in the Trauma Registry of the German Trauma Society (DGU) (1993–2003; n = 17,200) were subjected to univariate and multivariate logistic regression analysis to predict the probability for MT.

Results:

Clinical and laboratory variables available from data sets were screened for their association with mass transfusion. MT was defined by transfusion requirement of ≥10 units of packed red blood cells from emergency room (ER) to intensive care unit admission. Seven independent variables were identified to be significantly correlated with an increased probability for MT: systolic blood pressure (<100 mm Hg = 4 pts, <120 mm Hg = 1 pt), hemoglobin (<7 g/dL = 8 pts, <9 g/dL = 6 pts, <10 g/dL = 4 pts, <11 g/dL = 3 pts, and <12 g/dL = 2 pts), intra-abdominal fluid (3 pts), complex long bone and/or pelvic fractures (AIS 3/4 = 3 pts and AIS 5 = 6 pts), heart rate (>120 = 2 pts), base excess (<−10 mmol/L = 4 pts, <−6 mmol/L = 3 pts, and <−2 mmol/L = 1 pt), and gender (male = 1 pt). These variables were incorporated into a risk score, the Trauma Associated Severe Hemorrhage Score (TASH-Score, 0–28 points). Performance of the score was tested with respect to discrimination, precision, and calibration. Increasing TASH-Score points were associated with an increasing probability for MT.

Conclusion:

The TASH-Score is an easy-to-use scoring system that reliably predicts the probability for MT after multiple trauma. Taken as a surrogate for life threatening bleeding calculation may focus attention on relevant variables indicative for risk and impact strategies to stop bleeding and stabilize coagulation in acute trauma care.

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