Mclennan reported the Military Acute Severe Haemorhage (MASH) score. This can help to identify a soldier who may require massive transfusion. The authors are from Manchester University, Royal Centre for Defence Medicine, Royal Stoke University Hospital, Manchester Royal Infirmary andDerriford Hospital in England.
Patient selection: battlefield trauma
Outcome: massive transfusion protocol (>= 6 units of red blood cells in 4 hours or >= 10 in 24 hours)
Sections (14):
(1) injuries sustained (first 7 items)
(2) physiology (next 4 items)
(3) treatment received or required (last 4 items)
Parameters:
(1) number of amputated limbs (from 0 to 4)
(2) number of femoral fractures (open or closed; from 0 to 2)
(3) number of open tibial fractures (from 0 to 2)
(4) severe pelvic injury (open, unstable, partially unstable fracture)
(5) severe arterial bleeding (proximal limb, groin, axilla, neck)
(6) hemothorax on chest X-ray
(7) FAST exam for free fluid in the abdomen or pelvis
(8) heart rate in beats per minute
(9) systolic blood pressure in mm Hg
(10) respiratory rate in breaths per minute
(11) Glasgow coma score (GCS)
(12) pre-hospital blood products given
(13) tourniquet required to control bleeding (prehospital or ED)
(14) hemostatic agent required to control bleeding (prehospital or ED)
|
Parameter |
Finding |
Points |
|
number of amputated limbs |
|
MIN(4, number) |
|
number of femoral fractures |
|
MIN(2, number) |
|
number of open tibial fractures |
|
MIN(2, number) |
|
severe pelvic injury |
no |
0 |
|
|
yes |
1 |
|
severe arterial bleeding |
no |
0 |
|
|
yes |
1 |
|
hemothorax |
no |
0 |
|
|
yes |
1 |
|
FAST |
negative |
0 |
|
|
positive |
1 |
|
heart rate |
< 100 beats per minute |
0 |
|
|
>= 100 beats per minute |
1 |
|
systolic blood pressure |
>= 110 mm Hg |
0 |
|
|
< 110 mm Hg |
1 |
|
respiratory rate |
< 30 breaths per minute |
0 |
|
|
>= 30 breaths per minute |
1 |
|
GCS |
15 |
0 |
|
|
3 to 14 |
1 |
|
prehospital transfusion |
no |
0 |
|
|
yes |
1 |
|
tourniquet |
no |
0 |
|
|
yes |
1 |
|
hemostatic agent |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 14 parameters)
Interpretation:
• minimum score: 0
• maximum score 19
|
Score |
Massive Transfusion Protocol |
|
0 or 1 |
no need |
|
2 |
observe |
|
>= 3 |
activate for institution |
Performance:
• The area under the ROC curves was 0.93.
Specialty: Clinical Laboratory, Surgery, general, Emergency Medicine
