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Background: Exsanguination can be fatal in patients with traumatic brain injury (TBI). We aimed to analyze and compare the prognostic performances of injury severity score (ISS), revised trauma score (RTS), shock index (SI), and modified early warning score (MEWS) for predicting massive transfusion (MT) in severe trauma patients with TBI., Methods: In this retrospective observational study, severe trauma patients with TBI who visited our emergency department between January 2018 and December 2020 were included in the study. TBI was considered when abbreviated injury scale was 3 or higher. The primary outcome was MT., Results: A total of 1108 patients were included, and MT was performed in 92 (8.3%) patients. Receiver operating characteristic analyses were performed to evaluate the accuracy of ISS, RTS, SI, and MEWS for predicting MT. The area under curves (AUCs) of ISS, SI, RTS, and MEWS for predicting MT were 0.725 (95% confidence interval [CI], 0.698-0.751), 0.676 (95% CI, 0.648-0.704), 0.769 (95% CI, 0.743-0.793), and 0.808 (95% CI, 0.784-0.831), respectively. The AUC of MEWS was significantly different from the AUCs of ISS and SI but not the AUC of RTS for predicting MT. In a multivariate analysis, Glasgow Coma Scale (odds ratio [OR], 0.856; 95% CI, 0.803-0.911), body temperature (OR, 0.596; 95% CI, 0.386-0.920), and fresh frozen plasma (OR, 2.031; 95% CI, 1.794-2.299) were independently associated with MT. MEWS (OR, 1.425; 95% CI, 1.256-1.618) was independently associated with MT after adjustment for confounders., Conclusion: MEWS may be a useful tool for predicting MT in severe trauma patients with TBI.

In this study, the effect of graphene oxide nanosheets (GONs) embedded in a thin-film composite (TFC) polyamide (PA) membrane on the acid resistance of the membrane was investigated by comparison with the effect of oxidized single-walled carbon nanotubes (o-SWNTs). Both GONs and o-SWNTs increased the hydrophilicity of the membranes and caused the formation of ridges and clustered bumps on the surfaces, resulting in slightly improved water permeability. However, the o-SWNTs-embedded membrane did not show a difference in acid resistance depending on the concentration of embedded material, but the acid resistance of the GONs-embedded membrane increased with increasing concentration. The acid resistance of the GONs-embedded membranes appears to be mainly due to the barrier effect caused by the nanosheet shape of the GONs along with a sacrificial role of the PA layer protruded by the addition of GONs and the decrease of acid reaction sites by the hydrogen bonding between GONs and PA. When the TFC PA membrane was prepared with a high amount (300 ppm) of the GONs without considering aggregation of GONs, membrane selectivity exceeding 95% was maintained 4.7 times longer than the control TFC membrane. This study shows that the acid resistance can be enhanced by the use of GONs, which give a barrier effect to the membrane.