Trauma Associated Severe Hemorrhage (TASH)-Score: Probability of Mass Transfusion as Surrogate for Life Threatening Hemorrhage after Multiple Trauma

TLDR

The authors aimed to develop a simple scoring system that can estimate early the probability of mass transfusion as a surrogate for life‑threatening hemorrhage after multiple trauma. They performed univariate and multivariate logistic regression on 17,200 trauma registry cases to identify predictors, constructed the Trauma Associated Severe Hemorrhage (TASH) score, and evaluated its discrimination, precision, and calibration. Seven variables (systolic blood pressure, hemoglobin, intra‑abdominal fluid, long bone/pelvic fractures, heart rate, base excess, and gender) were weighted to produce a 0–28 point score, with higher scores strongly associated with increased mass‑transfusion risk, demonstrating the TASH score’s reliable predictive value.

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 ≥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. Conclusion: 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.