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Background: Early identification of massive transfusion (MT) requirement in geriatric patients with severe trauma is challenging. Existing systems for predicting MT need in trauma patients have not been systematically evaluated for their relevance to the geriatric population. This study aimed to evaluate the predictive accuracy of initial vital signs and the Glasgow coma scale (GCS) in geriatric trauma patients for predicting MT. Methods: We conducted a retrospective review involving data from geriatric patients with severe trauma admitted to our Level I trauma center for an observational study and to develop a prognostic model for MT using logistic regression. The new trauma scoring system was compared with the existing scoring systems. Results: A total of 193 patients with exhaustive medical records were included in the analysis; 19 (9.8%) of them received MT. A new trauma scoring system, RHG, was calculated, which involved GCS score, heart rate, and respiratory rate. Compared with existing trauma scores, our novel model, RHG, yielded the highest area under the receiver operating characteristic (ROC) curve for the prediction of MT (0.861; 95% confidence interval [CI], 0.788 - 0.933). The RHG exhibited a robust sensitivity of 90.0% and a respectable specificity of 75.3% in identifying MT. Conclusions: The RHG scoring system is a simplified, yet powerful, tool for predicting the necessity of MT in geriatric patients with severe trauma. By utilizing just the GCS score, heart rate, and respiratory rate, it offers an early indicator of MT requirement, eliminating the need for sophisticated equipment. [ABSTRACT FROM AUTHOR]