TASH Score for Severe Hemorrhage Calculator

How does this TASH score for severe hemorrhage calculator work?

This is a health tool that assesses the need of massive transfusion in a patient suffering from traumatic triggered hemorrhage. The acronym TASH comes from Trauma Associated Severe Hemorrhage and exemplifies the purpose of the score in predicting on going hemorrhage and transfusion requirements.

The TASH score for severe hemorrhage calculator uses the following criteria based on the original model:

■ Patient gender – with a higher weighted risk for male patients.

■ Systolic blood pressure during the first clinical assessment, with lower values posing a great risk in needing MT.

■ Heart rate – with any increase above 120 being problematic in the clinical setting.

■ Hemoglobin – clinical determination allowing the professional to check the blood condition and the severity of an existing apparent or hidden, diffuse hemorrhage.

■ Base excess - Base deficit and lactate are correlated with hemorrhagic shock and at one hour after admission is often used in mortality scores especially when associated with severe pelvic fractures.

■ Positive FAST for intra-abdominal fluid – this ultrasound determination is used to show significant bleeding in peritoneal, pleural or pericardial spaces.

■ Clinically unstable pelvic fracture – one major risk factor in trauma patients, raises the score result by a weighted 8 points.

■ Open or dislocated femur fracture – another major risk factor of organ damage and hemorrhage with a weighted 3 points.

TASH score interpretation

The score provides reliable information on the probability of the multiple trauma patient to reach a life threatening hemorrhage state and of having to undergo mass transfusion.

Each of the factors described above has several answer choices that weigh a different number of points. The overall score is obtained by adding the points together.

TASH scores as validated through several studies vary from 0 to 31 while probability of transfusion needed increases with the score. It is essential for this assessment to be done in due time to prevent any complications and an increase in morbidity or mortality.

Massive transfusion guidelines

These protocols are triggered when there is a suspicion of existing or impending hemorrhagic shock in a patient who is already bleeding. MT is defined as administering more than 10 red cell concentrate units RCs or in transfusion of an entire blood volume the first 24 hours after trauma or replacement of 50% blood volume over 3 hours. Some of the most common massive transfusion protocols include 1:1:1 or 1:1:2 for fresh frozen plasma, platelets and packed red blood cells.

Essential factors to be considered before commencing MT procedures include:

■ Patient age and gender;

■ The mechanism of injury;

■ Blood components given on the way to ER;

■ Bleeding disorders and coagulopathies;

■ Known bleeding diathesis;

■ History of previous transfusions, antibodies.

Massive hemorrhage is one of the death causes in patients with severe trauma, a cause than can be avoided in about 3% of the cases.

There are several prediction and risk stratification models such as the Assessment of Blood Consumption (ABC) or the McLaughlin scores which provide useful information to clinicians and help them set trauma management strategies and to begin coagulation therapies. Most of them have been validated in trauma and ICU settings for different demographics and often precede MT protocols. Although ABC is a more specific score with higher accuracy, the TASH score proves to be more useful in the early stages following a severe injury.

References

1 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. (2006) Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma; 60(6):1228-36; discussion 1236-7.

2) 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). (2011) 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; 100(2):231-8.

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