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Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics.

Methods

In this prospective study, the ISS was determined prehospital by emergency physicians. The validated AIS and ISS were analyzed based on final diagnoses. A Bland–Altman plot was used in analyzing the agreement between two different assays as well as sensitivity and specificity were determined. Confidence intervals were calculated for a Wilson score. Significance level was set at p ≤ 0.05.

Results

The prehospital ISS was estimated at 26.0 ± 13.0 and was 34.7 ± 16.3 (p < 0.001) after in-hospital validation. In addition, most of the AIS subgroups were significantly higher in the final calculation than preclinically estimated (p < 0.05). When analyzing subgroups of trauma patients (ISS < 16 vs. ISS ≥ 16), we were able to demonstrate a sensitivity of > 90% to identify a multiple-trauma patient. Diagnosing a higher injury severity group (ISS ≥ 25), sensitivity dropped to 61.1%. The Bland–Altman plot demonstrates that injury severity is underestimated in higher injury levels.

Conclusion

Multiple-trauma patients can be identified using the ISS. Anatomic scores might be used for transport decisions; however, an accurate estimation of the injury severity should also be based on other criteria such as patient status, mechanism of injury, and other triage criteria.

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Acknowledgements

This study was part of the doctoral thesis of Florian Urbanek. The authors state that there are no competing interests.

Author information

Authors and Affiliations

  1. Trauma Department, Hanover Medical School, Hanover, Germany

    C. Schröter, F. Urbanek, M. Winkelmann, P. Mommsen, C. Krettek & C. Zeckey

  2. Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany

    C. Zeckey

  3. Faculty III, Dept. Information and Communication, University of Applied Sciences and Arts Hannover, Hanover, Germany

    C. Frömke

  4. Trauma Department, Wolfsburg Hospital, Wolfsburg, Germany

    C. Schröter

Authors
  1. C. Schröter
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  2. F. Urbanek
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  3. C. Frömke
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  4. M. Winkelmann
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  5. P. Mommsen
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  6. C. Krettek
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  7. C. Zeckey
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Corresponding author

Correspondence to C. Zeckey.

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Conflict of interest

Christian Schröter, Florian Urbanek, Cornelia Frömke, Marcel Winkelmann, Philipp Mommsen, Christian Krettek, and Christian Zeckey declare that they have no conflict of interest.

Research involving human participants and/or animals

The study was approved by the Ethical Committee of Hannover Medical School (ID 3438-2016) and followed the declaration of Helsinki in its latest version.

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Schröter, C., Urbanek, F., Frömke, C. et al. Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue. Eur J Trauma Emerg Surg 45, 83–89 (2019). https://doi.org/10.1007/s00068-017-0888-1

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  • DOI: https://doi.org/10.1007/s00068-017-0888-1

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