title: Modified traumatic bleeding severity score: early determination of the need for massive transfusion.
abstract: BACKGROUND
  Determination of the need for massive transfusion (MT) is essential for early activation of a MT protocol. The Traumatic Bleeding Severity Score (TBSS) predicts the need for MT accurately, but takes time to determine because systolic blood pressure after a 1000mL of crystalloid infusion is used. The aim of this study is to determine the how well the Modified TBSS (age, sonography, pelvic fracture, serum lactate and systolic blood pressure on arrival) predicts the need for MT (accuracy).
  
  
  METHODS
  This is a single-center retrospective study of trauma patients (Injury Severity Score ≧16) admitted between 2010 and 2014. The TBSS, the Trauma Associated Severe Hemorrhage (TASH) Score, and the Modified TBSS were calculated. MT is defined as ≧10 U packed red blood cell transfusion within 24hours of injury, and the predictive value of the need for MT was compared by area under the receiver operating characteristic curve (AUC) analysis among three scores.
  
  
  RESULTS
  Three hundred patients were enrolled, and MT given to 25% of patients. Although the AUC of the TBSS was higher than that of the TASH score (0.956 vs 0.912, P=.006) and the Modified TBSS (0.956 vs 0.915, P=.001), there was no difference between the AUC of the Modified TBSS and the TASH score. The Modified TBSS has high accuracy, within an AUC >0.9.
  
  
  CONCLUSIONS
  The predictive value of the Modified TBSS of the need for MT is still high and is equivalent to the TASH score. The Modified TBSS is calculated earlier in resuscitation than the original TBSS.
authors.affiliation: Advanced Medical Emergency Department & Critical Care Center, Japan Red Cross Maebashi Hospital, Japan. Electronic address: alongthelongestway2003@yahoo.co.jp.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan. Electronic address: alefor@jichi.ac.jp.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Advanced Medical Emergency Department & Critical Care Center, Japan Red Cross Maebashi Hospital, Japan. Electronic address: masuda.mamoru924@gmail.com.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: kussie@emergency-medicine.med.tohoku.ac.jp.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kushimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy