Severe Hemorrhage TASH Score

Predicts need for massive transfusion in the case of trauma patients.

You can find more information about the items in the score, about its interpretation and about the original study in the text below the calculator.


The acronym TASH comes from Trauma Associated Severe Hemorrhage.

The TASH score checks how likely a patient is to require massive transfusion following traumatic triggered haemorrhage.

The score is based on 8 items that refer to patient clinical data such as haemoglobin or systolic blood pressure and to characteristics of the trauma, for example if an open or dislocated femur fracture is present.


The association between the possible TASH scores and the massive transfusion probability can be found in the table below:

TASH score (points) Massive transfusion probability TASH score (points) Massive transfusion probability
0 - 8 <5% 17 43%
9 6% 18 50%
10 8% 19 57%
11 11% 20 65%
12 14% 21 71%
13 18% 22 77%
14 23% 23 82%
15 29% 24 85%
16 35% 25 - 31 >85%

1

Patient gender

2

Systolic Blood Pressure

3

Heart Rate

4

Hemoglobin

5

Base Excess

6

Positive FAST for intra-abdominal fluid

7

Clinically unstable pelvic fracture

8

Open or dislocated femur fracture

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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:

TASH score items Answer choices (points) Description
Patient gender Male (1)
Female (0)
There is a higher risk in male patients.
Systolic Blood Pressure <100 mmHg (4)
<120 mmHg (1)
≥120 mmHg (0)
Systolic BP taken during the first clinical assessment, with lower values posing a great risk in needing MT.
Heart Rate >120 bpm (2)
≤120 bpm (0)
Increases over 120 beats per minute become problematic.
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)
Hb value from blood test allows the clinician to check the severity of an existing apparent or hidden, diffuse hemorrhage.
Base Excess <-10 mmol/L (4)
<-6 mmol/L (3)
<-2 mmol/L (1)
≥-2 mmol/L (0)
Base deficit and lactate are correlated with hemorrhagic shock.
Positive FAST for intra-abdominal fluid Yes (3)
No (0)
Ultrasound determination that is used to check for significant bleeding in peritoneal, pleural or pericardial spaces.
Clinically unstable pelvic fracture Yes (6)
No (0)
Major risk factor in trauma patients.
Open or dislocated femur fracture Yes (3)
No (0)
Major risk factor of adverse outcome.

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:

TASH score (points) Massive transfusion probability TASH score (points) Massive transfusion probability
0 - 8 <5% 17 43%
9 6% 18 50%
10 8% 19 57%
11 11% 20 65%
12 14% 21 71%
13 18% 22 77%
14 23% 23 82%
15 29% 24 85%
16 35% 25 - 31 >85%
 

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.


App Version: 1.0.1

Coded By: MDApp

Specialty: Hematology

System: Cardiovascular

Objective: Prediction

Type: Score

No. Of Items: 8

Year Of Study: 2006

Abbreviation: TASH

Article By: Denise Nedea

Published On: June 9, 2017 · 10:50 AM

Last Checked: June 9, 2017

Next Review: June 9, 2018