Predictive value of modified early warning score for massive transfusion in patients with traumatic brain injury

Exsanguination can be fatal in patients with traumatic brain injury (TBI). We aimed to analyze and compare the prognostic performances of injury severity score (ISS), revised trauma score (RTS), shock index (SI), and modified early warning score (MEWS) for predicting massive transfusion (MT) in severe trauma patients with TBI.

In this retrospective observational study, severe trauma patients with TBI who visited our emergency department between January 2018 and December 2020 were included in the study. TBI was considered when abbreviated injury scale was 3 or higher. The primary outcome was MT.

A total of 1108 patients were included, and MT was performed in 92 (8.3%) patients. Receiver operating characteristic analyses were performed to evaluate the accuracy of ISS, RTS, SI, and MEWS for predicting MT. The area under curves (AUCs) of ISS, SI, RTS, and MEWS for predicting MT were 0.725 (95% confidence interval [CI], 0.698-0.751), 0.676 (95% CI, 0.648-0.704), 0.769 (95% CI, 0.743-0.793), and 0.808 (95% CI, 0.784-0.831), respectively. The AUC of MEWS was significantly different from the AUCs of ISS and SI but not the AUC of RTS for predicting MT. In a multivariate analysis, Glasgow Coma Scale (odds ratio [OR], 0.856; 95% CI, 0.803-0.911), body temperature (OR, 0.596; 95% CI, 0.386-0.920), and fresh frozen plasma (OR, 2.031; 95% CI, 1.794-2.299) were independently associated with MT. MEWS (OR, 1.425; 95% CI, 1.256-1.618) was independently associated with MT after adjustment for confounders.

MEWS may be a useful tool for predicting MT in severe trauma patients with TBI.