From trauma resuscitation, a Chinese study trying to predict who will need massive transfusion after trauma. They have a 7-item scoring system retrospectively derived…and it’s probably not terribly helpful.
It’s a nice idea, considering there’s only so much blood readily available in the bank, and a lot of massive transfusion protocols are 1:1 with FFP and sometimes platelets, so advance warning based on the initial clinical evaluation would definitely be helpful. There are some interesting pieces of information in the paper, although, I wish they had all their OR listed for massive transfusion, as opposed to just the ones that shook out from their stepwise regression. Their highest predictor for massive transfusion – a hemoglobin < 7 g/dL with an OR 45.7. SBP < 90 and positive CT or FAST were also predictors with useful OR. Their rule is a little unusual for a theoretically beneficial intervention (massive transfusion), as they focus on specificity rather than sensitivity – probably due to a need to conserve blood component products.
In the end, though, I think most folks with a hypotensive trauma patient whose FAST is positive and a Hgb < 7 could clinically predict massive transfusion as well as this rule does.