title: Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma.
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 >or=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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Germany. n.yuecel@t-online.de
authors.forename: Nedim
authors.initials: N
authors.lastname: Yücel
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.forename: Matthias
authors.initials: M
authors.lastname: Vorweg
authors.forename: Thorsten
authors.initials: T
authors.lastname: Tjardes
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Edmund A M
authors.initials: EA
authors.lastname: Neugebauer
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Dieter
authors.initials: D
authors.lastname: Rixen
mesh_terms: D000328:Adult; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D015599:Trauma Severity Indices