Emergency Transfusion Score (ETS): A useful instrument for prediction of blood transfusion requirement in severely injured patients

Background Efficient blood transfusion management presents an ongoing challenge for many trauma centers. We present the Emergency Transfusion Score (ETS), a measure that may allow important time and cost savings in the treatment of severely injured patients in the Emergency Room (ER). Methods The ETS includes the parameters low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism. An ETS >= 3 indicates a transfusion probability of 5% and was set as the cut-off to order blood products (10 packed red blood cells [PRBC]/10 fresh frozen plasma [FFP]). Results A total of 481 patients requiring trauma team activation (ISS 18 +/- 18; 7/03-12/04) were prospectively included. The ETS was < 3 in 306 patients (64%) and >= 3 in 175 subjects (36%). Some 40 patients (8.3%) received blood (8 +/- 8 PRBC) after 23 +/- 9 min during ER treatment, and 39 of these patients had an ETS of >= 3 (5.4 +/- 1.5 points). Sensitivity of the ETS was 97.5%; specificity, 68%. Positive predictive value of the ETS was 0.222; negative predictive value, 0.998. Conclusions (1) The ETS is a safe and highly sensitive tool with which to detect severely injured patients in need of blood products. (2) The ETS is highly predictive for patients not in need of PRBC (negative predictive value 0.998) and helps to avoid unnecessary cross-matching and transport. (3) After implementation of the ETS, a sum of about 109,296 USD was saved per year by reducing the costs for cross-matching, transportation, and wasted blood products.