Identifying Transfusion Triggers in Trauma Patients and Developing the Vellore Trauma Transfusion Score: A Retrospective Cohort Study.

Abstract

Background and aims: Hemorrhage remains a leading cause of preventable mortality in trauma. Existing massive transfusion (MT) prediction scores are often context-specific and limited by resource availability. This study aimed to identify early transfusion predictors in a high-volume civilian trauma center and develop a simplified, locally applicable scoring system.

Patients and methods: This retrospective cohort study analyzed trauma registry data from a level 1 trauma center over 2 years (July 2022-July 2024). All trauma patients with an Injury Severity Score (ISS) ≥16 were included. Massive transfusion was defined using standard composite criteria. Clinical variables, imaging findings, and laboratory parameters were analyzed using logistic regression. Significant predictors were incorporated into a regression coefficient-based scoring system, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.

Results: Among 687 patients, 36 (5.2%) required MT. On multivariable analysis, systolic blood pressure (SBP) ≤90 mm Hg [odds ratio (OR) = 8.15], heart rate (HR) >120 bpm (OR = 4.27), packed cell volume (PCV) ≤30 (OR = 3.76), base deficit (BD) ≥6 mmol/L (OR = 4.15), lactate ≥5 mmol/L (OR = 2.62), and mean arterial pressure (MAP) <70 mm Hg (OR = 8.81) were significant predictors (all p < 0.01). Arterial pH was not predictive. A model incorporating SBP, HR, and BD demonstrated good calibration and fair discrimination [area under the curve (AUC) = 0.753]. A simplified three-variable score demonstrated high sensitivity (98.5%) when two or more parameters were positive.

Conclusion: A concise combination of physiological and biochemical parameters can reliably predict the need for MT. The proposed trauma transfusion trigger offers a pragmatic, context-sensitive tool requiring prospective validation.

How to cite this article: Das S, Jonish AP, Grace R, Chellaiya GK, Daniel D, Mathuram SR, et al. Identifying Transfusion Triggers in Trauma Patients and Developing the Vellore Trauma Transfusion Score: A Retrospective Cohort Study. Indian J Crit Care Med 2026;30(8):673-678.