Prediction of Life-Threatening Hemorrhage

Tools to identify life-threatening hemorrhage in traumatic injury can be valuable in activating a massive transfusion protocol, alerting the blood bank, and accelerating the delivery of critical blood products to the patient. Recent literature has identified that any delay in blood product delivery to the hemorrhaging patient is associated with potentially preventable death. In the past decade based on recent military experiences, the transition to the use of more plasma (which may require thawing) and platelets highlight the need for early recognition of life-threatening hemorrhage. While the process of initiating a massive transfusion protocol is often based upon clinical judgment, many clinical tools have been developed to assist in identifying patients who are at risk of exsanguination. Most of these tools are derived from retrospective studies, based on different definitions of a massive transfusion, and utilize a range of variables to calculate a predictive “score.” Other scoring systems have been developed to meet the needs of a particular trauma center or system, as has been done in the military. The following is a review of these scores and a description of the potential utility for predicting life-threatening hemorrhage.