For healthcare professionals
RABT score for massive transfusion
The RABT score (Revised Assessment of Bleeding and Transfusion) adds one point for each of four findings in an injured patient: a penetrating mechanism, a shock index above 1, a pelvic fracture and a positive FAST scan. A score of 2 or more is counted as positive for a likely need for massive transfusion. This tool is written for clinicians and is not a diagnosis.
Findings on arrival
Nothing you enter leaves this page.
The shock index is worked out for you: heart rate divided by systolic blood pressure.
What you will see
The RABT score from 0 to 4, the shock index, which items scored, and whether it reaches the published cutoff of 2.
Educational only, not medical advice. Not a diagnosis. Treatment decisions belong to the treating team.
Source
The four items, one point each, and the cutoff of 2 as printed in Pouroushaninia and colleagues, PLOS One 2026, with the shock index item as described by Barbosa Rengifo and colleagues, Scientific Reports 2024 (both open access, CC BY 4.0; licences checked in the Europe PMC full text). The original paper by Joseph and colleagues, World Journal of Surgery 2018, is cited, not quoted. The tests check every item, the shock index edge at exactly 1 and the cutoff of 2.
Validated in
Adult trauma patients. Pouroushaninia 2026: 329 adults at Sina Hospital in Tehran (July 2021 to December 2024) who received at least one unit of packed red blood cells. Barbosa Rengifo 2024: 620 patients with penetrating chest trauma and an Injury Severity Score above 9 at a trauma center in Cali, Colombia, in 2016.
Limits
The two open texts differ at a shock index of exactly 1: Barbosa Rengifo 2024 describes the item as a shock index greater than 1, Pouroushaninia 2026 prints 1 or more. This tool scores above 1 and shows both totals at exactly 1. Studies define massive transfusion differently: at least 3 units of packed red blood cells in the first 3 hours (Pouroushaninia 2026), or the critical administration threshold of 3 units within an hour (Barbosa Rengifo 2024). A FAST scan must have been done for that item to count; a score without it may be too low.
Items
| Finding | Points |
|---|---|
| Penetrating mechanism of injury | 1 |
| Shock index (heart rate divided by systolic blood pressure) above 1 | 1 |
| Pelvic fracture | 1 |
| Positive FAST (focused assessment with sonography for trauma) | 1 |
The total runs from 0 to 4. Scores of 2 or more are classed as positive (Pouroushaninia 2026). The RABT score revises the ABC score: it replaces the low blood pressure and fast heart rate items with a shock index above 1 and adds pelvic fracture (Barbosa Rengifo 2024). The score was first described by Joseph and colleagues (Joseph 2018).
Worked example: a stab wound with a heart rate of 120 per minute, systolic blood pressure 100 mmHg (shock index 1.2), no pelvic fracture and a negative FAST scores 1 (penetrating) + 1 (shock index) = 2, positive.
How it performed in a 2026 study
In 329 adult trauma patients in Tehran, 36 (10.9%) received a massive transfusion. A RABT score of 2 or more had (Pouroushaninia 2026):
| Measure | Value (95% CI) |
|---|---|
| Sensitivity | 63.9% (46.2 to 79.2) |
| Specificity | 93.5% (90.1 to 96.1) |
| Positive predictive value | 54.8% (38.8 to 70.2) |
| Negative predictive value | 95.5% (92.4 to 97.6) |
| C statistic | 0.81 (0.72 to 0.89) |
In the same study, patients with a RABT score of 2 or more had 25.5 times the odds of massive transfusion (95% CI 11.2 to 58.1) compared with a score below 2. The shock index, ABC and TASH scores performed in a broadly similar way, and the authors found no clear evidence that one score was better than the others. These are results from one hospital and depend on how often massive transfusion happened there.
Penetrating chest trauma
In 620 patients with penetrating chest trauma in Cali, Colombia, 53 (8.5%) reached the critical administration threshold. Because every patient had a penetrating injury, everyone started with 1 point. A RABT score of 2 or more had a sensitivity of 91% and a specificity of 49%, and the area under the curve was 0.768 (95% CI 0.709 to 0.827). In that group, the shock index alone and the ABC score did about as well, and the authors' new chest trauma score did better (Barbosa Rengifo 2024).
Related calculators
The shock index calculator gives the ratio on its own, with the trauma shock groups. The ABC score for massive transfusion uses a systolic blood pressure of 90 mmHg or lower and a heart rate of 120 or higher instead of the shock index. For injured children, the SIPA pediatric shock index reads the shock index against a cut point for age. For head injury, see the Glasgow Coma Scale calculator. Other bedside scores are listed under For healthcare professionals.
Sources
- Pouroushaninia N, Ramezani Z, Jahangiri A, Rahimimovaghar N, O'Reilly G, Baigi V, Rahimi-Movaghar V. Performance of four scoring systems in predicting the need for massive transfusion in Iranian trauma patients. PLoS One. 2026;21(7):e0353398. doi:10.1371/journal.pone.0353398. PMID 42424387. Open access (CC BY 4.0). Methods: RABT items (penetrating mechanism, shock index of 1 or more, pelvic fracture, positive FAST), one point each, 0 to 4, scores of 2 or more positive; Tables 3 to 5: C statistic, sensitivity, specificity, predictive values and odds ratio of RABT 2 or more in 329 trauma patients. pmc.ncbi.nlm.nih.gov/articles/PMC13349299/
- Barbosa Rengifo MM, Garcia AF, Gonzalez-Hada A, Mejia NJ. Evaluating the Shock Index, Revised Assessment of Bleeding and Transfusion (RABT), Assessment of Blood Consumption (ABC) and novel PTTrauma score to predict critical transfusion threshold (CAT) in penetrating thoracic trauma. Sci Rep. 2024;14(1):13395. doi:10.1038/s41598-024-62579-x. PMID 38862533. Open access (CC BY 4.0). Introduction and Discussion: RABT replaces the ABC blood pressure and heart rate items with a shock index greater than 1 and adds pelvic fracture; Tables 4 and 5: RABT AUC and operating characteristics in 620 patients with penetrating thoracic trauma. pmc.ncbi.nlm.nih.gov/articles/PMC11166957/
- Joseph B, Khan M, Truitt M, Jehan F, Kulvatunyou N, Azim A, et al. Massive transfusion: the Revised Assessment of Bleeding and Transfusion (RABT) score. World J Surg. 2018;42(11):3560-3567. doi:10.1007/s00268-018-4674-y. PMID 29785693. Original paper, cited, not quoted. doi.org/10.1007/s00268-018-4674-y
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-04. Spotted an error? See About.