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.