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ABC Score for Massive Transfusion

The ABC (Assessment of Blood Consumption) score gives 1 point each for penetrating mechanism, ED SBP ≤90 mmHg, ED heart rate ≥120 and positive FAST. A score ≥2 predicts massive transfusion (75% sensitive, 86% specific in derivation).

  • Penetrating mechanism (yes/no, +1)
  • ED arrival systolic BP (mmHg or kPa)
  • ED arrival heart rate (/min)
  • Positive FAST exam (yes/no, +1)
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Interpretation

ResultMeaning
0–1Massive transfusion not predicted
≥ 2Predicts massive transfusion: consider MTP

Formula

Penetrating mechanism 1 · ED SBP ≤90 mmHg 1 · ED HR ≥120 1 · Positive FAST 1. Score ≥2 → predicts MT.

Clinical pearls

  • Derivation: retrospective cohort of 596 adult level I trauma activations transported directly from scene (Vanderbilt); MT = ≥10 units PRBC in 24 h.
  • Specificity is imperfect; clinical gestalt and ongoing haemorrhage should drive MTP activation as much as the score.

Examples

abc score gsw abdomen, sbp 85, hr 130, fast positivemassive transfusion risk: blunt trauma, BP 110/70, HR 125, negative FAST

FAQ

What ABC score triggers massive transfusion?

A score of 2 or more.

Does the ABC score need lab values?

No, it uses only mechanism, vital signs and FAST, so it can be calculated on arrival.

Evidence

  1. Nunez TC et al. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma 2009;66:346–52.

Emergency & Trauma · Reviewed 2026-10-14 · Methodology