Abstract 13189: Traumatic Bleeding Severity Score (TBSS) based Initiation of Massive Transfusion Results in Earlier Transfusion and Improved Outcomes in Severely Injured Trauma Patients With Hemorrhagic Shock: A Prospective Interventional Study

Abstract

Introduction: The Traumatic Bleeding Severity Score (TBSS) classifies the need for massive transfusion (MT) in severely in cured trauma patients. We showed that 95% of trauma patients with TBSS >/= 17 need MT (Fig. 1, 2A). We hypothesized that the TBSS-guided activation of MT protocol can achieve early initiation of transfusion and improve the outcome of trauma patients with hemorrhagic shock. Methods: A single center prospective, interventional, and observational study was performed, which enrolled trauma patients admitted from 2013 to 2015 (TBSS-guided). In this group, the MT protocol was activated with a TBSS >/= 17 (Fig. 2B). Outcomes were compared with historical controls (2010-2012) who underwent MT, initiated without specific guidance (No-guidance). Patients resending in cardiac arrest or diagnosed with severe brain injury (GCS<6) were excluded. Results: A total of 119 patients were enrolled. The TBSS-guided group included 47, with 72 in the No-guidance group. There was no significant difference between the groups regarding injury severity score, vital signs, amount of transfusion, transfusion ratio ( red blood cells / fresh frozen plasma), and TBSS. In the TBSS-guided group, the time from admission to activation of MT protocol was shorter (100.1 minutes vs 32.7 minutes, p<0.001), the calculated probability of survival was lower (85.6% vs 75.0%, p=0.026), but observed 30-day survival was higher (91.5% vs 69.4%, p=0.004), compared to the No-guidance group. Conclusion: TBSS based initiation of MT results in earlier transfusion and improved outcomes of severely injured trauma patients with hemorrhagic shock.