Datasets of multiple injured patients entered into the TraumaRegister DGU® between 2002 and 2011 were analyzed. Inclusion criteria were age ≥ 16 years, primary admission, and complete datasets for base deficit upon admission blood gas analysis in the emergency department. Severe traumatic brain injury was defined by an AIShead ≥ 3 (abbreviated injury scale) as previously described [21-23]. Based on these criteria, 10,201 patients with severe TBI could be identified and were classified into four strata of worsening BD according to the recently proposed classification of hypovolemic shock (Table 1) [9]. Assessments included demographics, injury patterns and vital signs as present upon ED arrival. Additionally, therapeutic interventions such as administration of blood products, intravenous fluids and vasopressors were analyzed. The assessment of mortality was performed by analyzing the overall in-hospital mortality. Massive transfusion (MT) was defined by the administration of ≥ 10 blood products between ED arrival and ICU admission. Coagulopathy was defined by a Quick’s value ≤ 70%, which is equivalent to an international normalized ratio (INR) of approximately 1.3 [22,24]. For the evaluation of the applicability of the novel BD-based classification in the context of severe TBI, patients with an AIShead ≥ 3 were classified according to their BD at ED admission and compared to both, an unselected cohort of all trauma patients derived from the TraumaRegister DGU® as well as to patients without a significant TBI (no TBI). Subsequently, transfusion requirements within the different cohorts were assessed.