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Predicting the need for massive transfusion in trauma patients: The Traumatic Bleeding Severity Score

Ogura, Takayuki MD; Nakamura, Yoshihiko MD; Nakano, Minoru MD, PhD; Izawa, Yoshimitsu MD; Nakamura, Mitsunobu MD, PhD; Fujizuka, Kenji MD; Suzukawa, Masayuki MD, PhD; Lefor, Alan T. MD, MPH

Journal of Trauma and Acute Care Surgery: May 2014 - Volume 76 - Issue 5 - p 1243–1250
doi: 10.1097/TA.0000000000000200
Original Articles

BACKGROUND The ability to easily predict the need for massive transfusion may improve the process of care, allowing early mobilization of resources. There are currently no clear criteria to activate massive transfusion in severely injured trauma patients. The aims of this study were to create a scoring system to predict the need for massive transfusion and then to validate this scoring system.

METHODS We reviewed the records of 119 severely injured trauma patients and identified massive transfusion predictors using statistical methods. Each predictor was converted into a simple score based on the odds ratio in a multivariate logistic regression analysis. The Traumatic Bleeding Severity Score (TBSS) was defined as the sum of the component scores. The predictive value of the TBSS for massive transfusion was then validated, using data from 113 severely injured trauma patients. Receiver operating characteristic curve analysis was performed to compare the results of TBSS with the Trauma-Associated Severe Hemorrhage score and the Assessment of Blood Consumption score.

RESULTS In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p < 0.01). The area under the receiver operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively.

CONCLUSION The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility.

LEVEL OF EVIDENCE Prognostic study, level III.

From the Advanced Medical Emergency Department and Critical Care Center (T.O., Y.N., M. Nakano, M. Nakamura, K.F.), Japan Red Cross Maebashi Hospital, Maebashi; and Departments of Emergency Medicine (T.O., Y.I., M.S.), and Surgery (A.T.L.), Jichi Medical University, Tochigi, Japan.

Submitted: November 13, 2013, Revised: January 17, 2014, Accepted: January 22, 2014.

This study was presented at the American Heart Association Resuscitation Science Symposium 2012 in Los Angeles, California.

Address for reprints: Takayuki Ogura, MD, 371-0014 Asahi-cho 3-21-36, Maebashi, Gunma, Japan; email:

© 2014 Lippincott Williams & Wilkins, Inc.