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. 2024 Aug 9;13(16):4684. doi: 10.3390/jcm13164684

Table 2.

Bedside algorithms/clinical scoring systems to predict futile resuscitation. Abbreviations: ED, emergency department; GCS, Glasgow Coma Scale; ISS, injury severity score; LY30, lysis at 30 min; PRBC, packed red blood cell; ROSC, return of spontaneous circulation; SBP, systolic blood pressure; TIC, trauma-induced coagulopathy.

Study Scoring Criteria
Suspension of Transfusion and Other Procedures (STOP) [41] The proposed STOP criteria include any one of the combined clinical and lab markers below, each combination having a 100% PPV and specificity for death:

  1. Arrival SBP ≤ 50 and LY30 ≥ 30%;

  2. Arrival SBP ≤ 50 and lactate ≥ 15;

  3. Arrival SBP ≤ 70, lactate ≥15 and LY30 ≥ 30%;

  4. Prehospital/ED ROSC and LY30 ≥ 30%;

  5. Prehospital/ED ROSC and lactate ≥ 12;

  6. Prehospital/ED ROSC and GCS 3.
Trans-Agency Consortium for Trauma-Induced Coagulopathy (TACTIC) TIC Score [136]

  1. Normal hemostasis (negative);

  2. Mild coagulopathy, no intervention required except direct pressure or temporary gauze tamponade (equivocal);

  3. Coagulopathy refractory to direct pressure, requiring multiple routine hemostasis techniques (e.g., electrocautery, topic hemostatic agents, staples, or suturing) (possible positive);

  4. Coagulopathy requiring adjunctive blood component therapy or systemic therapeutics in response to continued bleeding despite the above surgical hemostatic maneuvers (positive);

  5. Diffuse persistent bleeding from multiple sites remote from injury, e.g., endotracheal tube, intravenous catheter, chest tubes, etc. (definitive positive);

  6. Potential use for future definition of futility.
National Blood Transfusion Committee Triage Tool for Massively Transfused Patients (NBTC TTMTP) [7]

  1. Sequential organ failure assessment (SOFA) score;

  2. Total blood components used;

  3. Need for ongoing transfusion support;

  4. Ability to control bleeding with either surgery or other procedures (e.g., interventional radiology, endoscopy).

Patients with a SOFA score > 11, who have a continued need for large amounts of blood components, and where there is no foreseeable ability to control blood loss should be triaged to palliative care.