The presented study was initiated to develop a scoring system for the prediction of red blood cell transfusion requirement in the early care of trauma patients. All trauma patients admitted to our institution who needed trauma team activation were evaluated during a 4-year period. A set of nine parameters with possible predictive value for the need of blood transfusion was recorded. All relevant data can be acquired during the first 10 min in the emergency room (ER). The data underwent multivariate logistic regression analysis for correlation and the calculation of predictive power. To transform the model into a practical score, we rounded all coefficients. The predictive power of the score was evaluated based on a linear regression equation. Of the 1103 patients (Injury Severity Score [ISS] 21 +/- 16) included in the study, 116 (10.5%; ISS 39 +/- 18) received blood in the ER. Early transfusion need was significantly correlated with systolic blood pressure (SBP) <90 mmHg (coefficient 2.5), SBP 90-120 mmHg (1.5), free fluid in abdominal ultrasound (2.0), clinically unstable pelvic ring fracture (1.5), age 20-60 years (0.5), age >60 years (1.5), admission from scene (1.0), traffic accident (1.0) and fall from >3 m (1.0). The probability for transfusion exponentially increased with the sum of points in the ER transfusion score, i.e. from 0.7% at one point to 5% at three points and 97% at 9.5 points maximum. To establish a practical cutoff point (risk <5%) a low-risk group was defined at

The finding of intraperitoneal fluid on US in the emergency department strongly correlates with significant intraabdominal lesions requiring surgical intervention. Early laparotomy appears indicated in these cases. Shock control in pelvic bleeding can be sufficiently achieved by internal tamponade and external fixation.

Despite intensified and standardised diagnostic procedures prescribed for use in trauma centres, injuries are still missed in severely injured patients. About 30% of lesions that are not diagnosed until after the patient has left the emergency room have clinically significant, but not lethal, consequences for the patient. Great importance attaches to the follow-up investigation on the intensive care station, so that lesions that have initially been overlooked can be diagnosed and treated as soon as possible so as to keep the complication rate low.

The clinical diagnosis of pelvic instability should result in an immediate order for blood products, taking surgical intervention into account. Pelvic radiographs in the ER are required for early surgical management. In patients with negative pelvis examination results, a routine pelvic radiograph is recommended because clinical examination cannot reliably rule out surgically significant pelvic fractures (20%) in the severely injured and intubated blunt trauma patient.