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Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients

Abstract

Purpose

We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard.

Methods

Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student’s T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p < 0.05 was considered significant.

Results

The final sample included 1361 trauma ICU patients. Median age was 45 (30–61) years. 1092 patients (80.3 %) were male. Median ISS was 18 (13–26) and median T-RTS was 11 (10–12). Median GAP was 20 (15–22) and median MGAP 24 (20–27). Observed mortality was 17.7 % whilst predicted mortality using TRISS was 16.9 %. The AUC in the scores evaluated was: TRISS 0.897 (95 % CI 0.876–0.918), MGAP 0.860 (95 % CI 0.835–0.886), GAP 0.849 (95 % CI 0.823–0.876) and T-RTS 0.796 (95 % CI 0.762–0.830).

Conclusions

Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.

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Affiliations

Authors

Corresponding author

Correspondence to J. A. Llompart-Pou.

Ethics declarations

Ethics Committee approval for the registry was obtained. The study was performed according to the Declaration of Helsinki Statement.

Conflict of interest

Juan Antonio Llompart-Pou, Mario Chico-Fernández, Marcelino Sánchez-Casado, Ruth Salaberria-Udabe, Cecilia Carbayo-Górriz, Francisco Guerrero-López, Javier González-Robledo, María Ángeles Ballesteros-Sanz, Rubén Herrán-Monge, Lluís Servià-Goixart, Rafael León-López and Estela Val-Jordán declare that they have no conflict of interest.

Funding

RETRAUCI received funding from the Fundación Mutua Madrileña during 3 years for the development of a web-based database Granted to the principal investigator (Dr. Chico-Fernández, AP117892013), on behalf of the GT Trauma y Neurointensivismo SEMICYUC.

Additional information

en representación del Grupo de Trabajo de Trauma y Neurointensivismo SEMICYUC.

The members of the collaborators names are listed in the Appendix.

Appendix

Appendix

Collaborators

Carlos García Fuentes, Luis Terceros Almanza, Susana Bermejo, Carolina Mudarra Reche, Isidro Prieto del Portillo (Hospital Universitario 12 Octubre), Iker García Sáez, Fermín Alberdi Odriozola (Hospital Universitario de Donostia), Javier Homar Ramírez, Jon Pérez Bárcena (Hospital Universitario Son Espases), María Dolores Mayor García (Complejo Hospitalario de Torrecárdenas), Eduardo Miñambres García (Hospital Universitario Marqués de Valdecilla), Juan José Egea Guerrero, María Dolores Freire Aragón, Gloria Rivera Rubiales (Hospital Universitario Virgen del Rocío), Ana Bueno González, Carmen Corcobado Márquez (Hospital General Universitario de Ciudad Real), Juan Francisco Fernández Ortega (Hospital Universitario Carlos Haya), Pedro Enríquez Giraudo, Ana Prieto de Lamo, Ángela González Salamanca, Marta García García (Hospital Universitario Río Hortega), José Roldán Ramírez, Eva Regidor, Juan Ángel Tihista Jiménez (Complejo Hospitalario de Navarra), Lucía López Amor, Lorena Martín Iglesias (Hospital Universitario Central de Asturias), Inés Martínez Arroyo (Hospital Miguel Servet), Manuel Quintana Díaz, Carola Gutiérrez (Hospital Universitario La Paz), María Lourdes Cordero Lorenzana (Complejo Hospitalario Universitario A Coruña), Carolina Sena Pérez (Hospital Universitario Ramón y Cajal), Ana Bueno González (Hospital General de Ciudad Real), Eva Tejerina Álvarez (Hospital Universitario de Getafe), María Inmaculada López Fernández (Hospital Universitario La Princesa), José Higinio de Gea García, María Martínez (Hospital Virgen de la Arrixaca), Margalida Vilar Vicens (Fundación Hospital de Manacor), Laura Claverías, Gerard Moreno, Alejandro Rodríguez, (Hospital Joan XXIII), Ion Santacana González (Policlínica Nuestra Señora del Rosario), José Manuel Jiménez Moragas, Mikel Celaya López, Rocío Monterroso Pintado (Hospital Universitario Puerta del Mar), Luis Marina (Hospital Virgen de la Salud), José María Toboso Casado (Hospital Univ. Germans Trias i Pujol), Ana Tejero Mogena, Ana Vallejo de la Cueva (Hospital Universitario Araba), Ramón Fernández-Cid Bouza (Hospital Mateu Orfila), Carlos López Núñez (Hospital General Obispo Polanco).

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Llompart-Pou, J.A., Chico-Fernández, M., Sánchez-Casado, M. et al. Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients. Eur J Trauma Emerg Surg 43, 351–357 (2017). https://doi.org/10.1007/s00068-016-0671-8

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Keywords

  • Trauma
  • Scales
  • Scoring
  • Mortality prediction