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Review of Existing Scoring Systems for Massive Blood Transfusion in Trauma Patients

Where Do We Stand?

El-Menyar, Ayman*,†; Mekkodathil, Ahammed*; Abdelrahman, Husham; Latifi, Rifat§; Galwankar, Sagar||; Al-Thani, Hassan; Rizoli, Sandro

doi: 10.1097/SHK.0000000000001359
Review Articles

Background: Uncontrolled bleeding is the main cause of the potential preventable death in trauma patients. Accordingly, we reviewed all the existing scores for massive transfusion posttraumatic hemorrhage and summarized their characteristics, thus making it easier for the reader to have a global view of these scores—how they were created, their accuracy and to which population they apply.

Methods: A narrative review with a systematic search method to retrieve the journal articles on the predictive scores or models for massive transfusion was carried out. A literature search using PubMed, SCOPUS, and Google scholar was performed using relevant keywords in different combinations. The keywords used were “massive transfusion,” “score,” “model,” “trauma,” and “hemorrhage” in different combinations. The search was limited for full-text articles published in English language, human species and for the duration from January 1, 1998 to November 30, 2018.

Results: The database search yielded 295 articles. The search was then restricted to the inclusion criteria which retrieved 241 articles. Duplicates were removed and full-texts were assessed for the eligibility to include in the review which resulted in inclusion of 24 articles. These articles identified 24 scoring systems including modified or revised scores. Different models and scores for identifying patients requiring massive transfusion in military and civilian settings have been described. Many of these scorings were complex with difficult calculation, while some were simple and easy to remember.

Conclusions: The current prevailing practice that is best described as institutional or provider centered should be supplemented with score-based protocol with auditing and monitoring tools to refine it. This review summarizes the current scoring models in predicting the need for MT in civilian and military trauma. Several questions remain open; i.e., do we need to develop new score, merge scores, modify scores, or adopt existing score for certain trauma setting?

*Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar

Clinical Medicine, Weill Cornell Medical College, Doha, Qatar

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar

§Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York

||Department of Emergency Medicine, Sarasota Memorial Hospital and Florida State University, Sarasota, Florida

Address reprint requests to Ayman El-Menyar, MD, FRCP , FACC, Weill Cornell Medical Scholl and Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar. E-mail:,

Received 8 March, 2019

Revised 26 March, 2019

Accepted 9 April, 2019

All authors contributed substantially in the design of the study interpretation of the data, writing the manuscript, and approving the submission.

The authors report no conflicts of interest.

© 2019 by the Shock Society