Advanced Trauma Life Support ATLS Student Course Manual 2018

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TRAUMA SCORES
geriatric patient. The Geriatric Trauma Outcome Score
(GTOS) was developed to address this concern. It is
based on three a priori variables: age, ISS, and 24-hour
transfusion requirement. GTO = Age + (2.5 × ISS) + 22
(if any pRBCs are transfused in the first 24 hours after
injury). A nomogram correlating GTOS to probability
of mortality was created.
Timely initiation of massive transfusion protocols
has been shown to impact survival and decrease waste
of blood products. Precise approaches to implement
this strategy have, however, not been defined. Several
scoring systems have been developed to aid the clinician
in making this difficult decision. To be useful, the score
must be easily calculated and based on data available
either immediately or shortly after patient admission
to the emergency department. The simplest is the ABC
score. It requires four data points: penetrating trauma
mechanism, SBP < 90 mm Hg, HR > 120 bpm, and
positive FAST. Each variable receives a score of 1 if
present, for a maximum score of 4. The need for massive
transfusion is defined by a score of 2 or greater.
The Trauma Associated Severe Hemorrhage
(TASH) Score is more complex. It is calculated from
seven variables: SBP, hemoglobin, FAST, presence
of long-bone or pelvic fracture, HR, base excess
(BE), and gender. The variables are weighted and
the score is calculated by adding the components.
(n TABLE X-1) A 50% probability of need for massive
transfusion was predicted by a score of 16, and a score
of greater than 27 was 100% predictive of the need for
massive transfusion.
The McLaughlin score uses four variables to predict
the need for massive transfusion: HR > 105, SBP
>110 mm Hg, PH < 7.25, and hematocrit < 32%. Each
variable present indicates a 20% incidence of massive
transfusion. When all four variables are present, an
80% likelihood of the need for massive transfusion
was present.
Bibliography
1. Centers for Disease Control and Prevention.
Guidelines for Field Triage of Injured Patients:
Recommendations of the National Expert
Panel on Field Triage, 2011. http://www.cdc.
gov/mmwr/preview/mmwrhtml/rr6101a1.htm.
Accessed April 18, 2017.
2. Cotton BA, Dossett LA, Haut ER, et al. Multicenter
validation of a simplified score to predict
massive transfusion in trauma. J Trauma 2010
July;69(1):S33–S39.
3. Guidelines for field triage of injured patients:
recommendations of the National Expert Panel
table x-1 tash score calculation
VARIABLE RESULT SCORE
Gender Male 1
Female 0
Hemoglobin < 7 g/dL 8
< 9 g/dL 6
< 10 g/dL 4
< 11 g/dL 3
< 12 g/dL 2
≥ 12 g/dL 0
Base excess < –10 mmol/L 4
Systolic blood
pressure
< –6 mmol/L 3
< –3 mmol/L 1
≥ –2 mmol/L 0
< 100 mm Hg 4
< 120 mm Hg 1
≥ 120 mm Hg 0
Heart rate > 120 2
≤ 120 0
Positive FAST Yes 3
Unstable pelvis
fracture
Open or dislocated
femur fracture
No 0
Yes 6
No 0
Yes 3
No 0
Data from: Holcomb JB, Tilley BC, Baraniuk S, Fox EE, et al. Transfusion
of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and
mortality in patients with severe trauma: the PROPPR randomized
clinical trial. JAMA 2015 Feb 3;313(5):471-482.
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