title: Predicting the need for massive transfusion in trauma patients: the Traumatic Bleeding Severity Score.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: 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.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ogura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Minoru
authors.initials: M
authors.lastname: Nakano
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Izawa
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Nakamura
authors.forename: Kenji
authors.initials: K
authors.lastname: Fujizuka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Suzukawa
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
mesh_terms: D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D015996:Survival Rate; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult