Severe Hemorrhage TASH Score

The scoring method explained

The TASH score predicts likelihood of massive transfusion in patients suffering from traumatic triggered hemorrhage. The acronym TASH comes from Trauma Associated Severe Hemorrhage.

The score consists of 8 items that refer to patient clinical data and to trauma characteristics:

An early application of the score can help clinicians with trauma patient management and with timely arrangements for transfusion and patient monitoring.

Result interpretation

Each of the above 8 items are weighted depending on their MT prediction capacity.

The overall score is obtained by adding the points together and varies between 0 and 31. The higher the score, the higher the possibility of a transfusion.

The table below introduces the TASH scores and their massive transfusion probability:

About the study

TASH score was created by Yücel et al. in 2006, following a retrospective study on data from the Trauma Registry of the German Trauma Society.

Several clinical and laboratory variables were screened for their association with mass transfusion, which was defined by the study as transfusion requirement of 10 or more units of packed red blood cells and ICU admission.

The variables significantly correlated with an increased probability for MT were selected and incorporated in a risk scoring.

Performance of the new model was tested for power of discrimination, precision, and calibration.

The TASH scoring system was found to provide an early and reliable estimation of how likely the patient is to need mass transfusion in life threatening, multiple trauma induced haemorrhage.

Massive transfusion guidelines

MT protocols, such as 1:1:1 or 1:1:2 for fresh frozen plasma, platelets and packed red blood cells, are triggered for patients suspected of impending haemorrhaging shock.

The factors that are considered before initiating mass transfusion include:

■ Patient age and gender;

■ Injury mechanism (trauma or internal);

■ Blood components already administered on the way to ER;

■ Bleeding disorders and coagulopathies;

■ Known bleeding diathesis;

■ History of previous transfusions, antibodies.

The main definition of massive transfusion refers to the administration of more than 10 red cell concentrate units RCs or transfusion of an entire blood volume the first 24 hours after trauma or replacement of 50% blood volume over 3 hours.

It is considered that death can be avoided in about 3% of patients with severe trauma if MT protocols are triggered in time.

There are several prediction models such as the Assessment of Blood Consumption (ABC) or the McLaughlin score which help clinicians with haemorrhage management and initiation of coagulation therapies. These are scores that have been widely validated in trauma and ICU settings and ensure high accuracy.

Original source

Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, Neugebauer EA, Wappler F, Bouillon B, Rixen D; Polytrauma Study Group of the German Trauma Society. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006; 60(6):1228-36; discussion 1236-7.

Validation

Maegele M, Lefering R, Wafaisade A, Theodorou P, Wutzler S, Fischer P, Bouillon B, Paffrath T; Trauma Registry of Deutsche Gesellschaft für Unfallchirurgie (TR-DGU). Revalidation and update of the TASH-Score: a scoring system to predict the probability for massive transfusion as a surrogate for life-threatening haemorrhage after severe injury. Vox Sang. 2011; 100(2):231-8.

Other references

1. Krumrei NJ, Park MS, Cotton BA, Zielinski MD. Comparison of massive blood transfusion predictive models in the rural setting. J Trauma Acute Care Surg. 2012; 72(1):211-5.

2. Maegele M. Frequency, risk stratification and therapeutic management of acute post-traumatic coagulopathy. Vox Sang. 2009; 97(1):39-49.