Trauma patients at risk for massive transfusion: the role of scoring systems and the impact of early identification on patient outcomes.

Hemorrhage remains one of the most common causes of early death in severely injured patients. It is also the most common preventable cause of death in this population. More than 80% of deaths in the operating room and nearly 50% in the first 24 h after injury are related to hemorrhagic shock. Among the injured patients, up to 3-5% admitted to trauma centers will receive a massive transfusion (MT). This population may benefit from activation of MT protocols that are associated with decreased mortality and reduced overall blood transfusions. Using damage-control resuscitation and 1:1 ratios of blood components are associated with increased survival. However, the survival benefit of damage-control resuscitation and MT protocols is primarily in the first 24 h and is most impressive when these strategies are employed early. New scoring systems in conjunction with laboratory data have contributed to early objective identification of those patients requiring MT. Activating these protocols early and with an organized team approach is critical to achieving their full benefit.