Predictive value of the glasgow coma scale, age, and arterial blood pressure and the new trauma score indicators to determine the hospital mortality of multiple trauma patients

Authors

1 Department of Medical Emergencies, Sirjan School of Medical Sciences, Sirjan, Iran

2 Prehospital Medical Emergency Organization, Sirjan School of Medical Sciences, Sirjan, Iran

3 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Authoritative trauma scoring systems can quickly assess the damage and show its severity plus prognosis. The purpose of this study was to investigate the predictive value of the new Glasgow Coma Scale, age, and systolic blood pressure (GAP) and the new trauma score (NTS) indicators to determine the mortality of trauma patients in hospitals in Sirjan in 2019. Materials and Methods: In a descriptive-analytical study, 2570 patients with multitrauma caused by traffic accidents transferred by the prehospital emergency were enrolled in the study. Demographic variables of patients as well as GAP and NTSs were collected and calculated, with the outcome of patients followed up and recorded during hospitalization. The predictive value of these scores was determined in clarifying the outcome of patients using SPSS software. Results: Of the total number of patients studied, 14 (0.5%) patients died during hospitalization. The mean GAP and NTS scores in dead patients were 12.78 ± 6.92 and 11.64 ± 7.36, respectively. Furthermore, in surviving patients, they were 22.19 ± 1.12 and 22.30 ± 1.22, respectively, with a P < 0.05 in each case. Based on the above tools with 95% confidence level, the area under the curve for the mortality was 0.932 for the GAP system and 0.944 for the NTS (P > 0.001). Conclusions: Both indicators could predict the mortality of patients with multitrauma. It could also be used to determine the priority of dispatch at the scene of the accident and the triage of the injured (people). Based on the results of the receiver operating characteristic curve, the NTS score has a higher accuracy

Keywords

References

  1. World Health Organization. (2014). Injuries and violence: the facts 2014. World Health Organization. https://apps.who.int/iris/handle/10665/149798. [Last accessed on 2020 Feb 07].
  2. Alvarez BD, Razente DM, Lacerda DA, Lother NS, VON‑Bahten LC, Stahlschmidt CM. Analysis of the revised trauma score (RTS) in 200 victims of different trauma mechanisms. Rev Col Bras Cir 2016;43:334‑40.
  3. Sinclair N, Swinton PA, Donald M, Curatolo L, Lindle P, Jones S, et al. Clinician tasking in ambulance control improves the identification of major trauma patients and pre‑hospital critical care team tasking. Injury 2018;49:897‑902.
  4. Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent) 2010;23:349‑54.
  5.  Broska CA Jr., de Folchini AB, de Ruediger RR. Comparative study of trauma in the elderly and non‑elderly patients in a University Hospital in Curitiba. Rev Col Bras Cir 2013;40:281‑6.
  6. Shams Vahdati S, GhafarZad A, Rahmani F, Panahi F, Omrani Rad A. Patterns of road traffic accidents in North West of Iran during 2013 new year holidays: Complications and Casualties. Bull Emerg Trauma 2014;2:82‑5.
  7. Geraerds AJ, Haagsma JA, de Munter L, Kruithof N, de Jongh M, Polinder S. Medical and productivity costs after trauma. PLoS One 2019;14:e0227131.
  8. Miller RT, Nazir N, McDonald T, Cannon CM. The modified rapid emergency medicine score: A novel trauma triage tool to predict in‑hospital mortality. Injury 2017;48:1870‑7.
  9. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in‑hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care 2011;15:R191.
  10. Domingues Cde A, Nogueira Lde S, Settervall CH, Sousa RM. Performance of Trauma and Injury Severity Score (TRISS) adjustments: An integrative review. Rev Esc Enferm USP 2015;49 Spec No: 138‑46.
  11. Gabbe BJ, Cameron PA, Finch CF. Is the revised trauma score still useful? ANZ J Surg 2003;73:944‑8.
  12. Weeks SR, Juillard CJ, Monono ME, Etoundi GA, Ngamby MK, Hyder AA, et al. Is the Kampala trauma score an effective predictor of mortality in low‑resource settings? A comparison of multiple trauma severity scores. World J Surg 2014;38:1905‑11.
  13.  Lefering R, Huber-Wagner S, Bouillon B, Lawrence T, Lecky F, Bouamra O. Cross-validation of two prognostic trauma scores in severely injured patients. Eur J Trauma Emerg Surg. 2020; doi: 10.1007/s00068-020-01373-6.
  14.  Yousefzadeh-Chabosk S, Haghdoost Z, Mohtasham-Amiri Z, DavoudiKiakalayeh A, Razzaghi A, Kazemnegad-Leili E, et al. A new prehospital score to predict hospitalization in trauma patients. Arch Trauma Res 2017;6:25-30.
  15. Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med 1981;9:672‑6.
  16. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 
    1989;29:623‑9.
  17. Rabbani A, Moini M. Application of “Trauma and Injury Severity Score” and “A Severity Characterization of Trauma” score to trauma patients in a setting different from “Major Trauma Outcome Study”. Arch Iran Med 2007;10:383‑6.
  18. Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH, et al. The new trauma score (NTS): A modification of the revised trauma score for better trauma mortality prediction. BMC Surg 2017;17:77.
  19. Lalezarzadeh F, Wisniewski P, Huynh K, Loza M, Gnanadev D. Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in‑hospital mortality. Am Surg 2009;75:1009‑14.
  20. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): A new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 2010;38:831‑7.
  21. Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: Frequency, duration, and consequences. Arch Surg 2001;136:1118‑23.
  22. Spaite DW, Hu C, Bobrow BJ, Chikani V, Sherrill D, Barnhart B, et al. Mortality and prehospital blood pressure in patients with major traumatic brain injury: Implications for the hypotension threshold. JAMA Surg 2017;152:360‑8.
  23. Takahashi M, Kohsaka S, Miyata H, Yoshikawa T, Takagi A, Harada K, et al. Association between prehospital time interval and short‑term outcome in acute heart failure patients. J Card Fail 2011;17:742‑7.
  24. Herlitz J, Hansson E, Ringvall E, Starke M, Karlson BW, Waagstein L. Predicting a life‑threatening disease and death among ambulance‑transported patients with chest pain or other symptoms raising suspicion of an acute coronary syndrome. Am J Emerg Med 2002;20:588‑94.
  25. Hasler RM, Nuesch E, Jüni P, Bouamra O, Exadaktylos AK, Lecky F.
  26. Systolic blood pressure below 110 mmHg is associated with increased mortality in blunt major trauma patients: Multicentre cohort study. Resuscitation 2011;82:1202‑7.
  27. Wiles MD. Blood pressure management in trauma: From feast to famine? Anaesthesia 2013;68:445‑9.
  28. Filipescu R, Powers C, Yu H, Yu J, Rothstein DH, Harmon CM, et al. Improving the performance of the Revised Trauma Score using Shock Index, Peripheral Oxygen Saturation, and Temperature – A National Trauma Database study 2011 to 2015. Surgery 2020;167:821‑8.
  29.  Sittichanbuncha Y, Savatmongkorngul S, Jawroongrit P, Sawanyawisuth K. Low oxygen saturation is associated with 
    pre‑hospital mortality among non‑traumatic patients using emergency medical services: A national database of Thailand. Turk J Emerg Med 2015;15:113‑5.
  30. Guyette FX, Gomez H, Suffoletto B, Quintero J, Mesquida J, Kim HK, et al. Prehospital dynamic tissue oxygen saturation response predicts in‑hospital lifesaving interventions in trauma patients. J Trauma Acute Care Surg 2012;72:930‑5.
  31. Tan JH, Mohamad Y, Imran Alwi R, Henry Tan CL, Chairil Ariffin A, Jarmin R. Development and validation of a new simplified anatomic trauma mortality score. Injury 2019;50:1125‑32.
  32. Yadollahi M. A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017. Chin J Traumatol 2019;22:212‑8.
  33. Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross‑sectional study. Medicine (Baltimore) 2017;96:e7812.
  34. Schluter PJ, Nathens A, Neal ML, Goble S, Cameron CM, Davey TM, et al. Trauma and injury severity score (TRISS) coefficients 2009 revision. J Trauma 2010;68:761‑70.
  35.  Farzandipour M, Ghatan H, Mazrouei L, Nejati M, Agha BT. Epidemiological study of traumatic patients referred to neghavi hospital of kashan. J Inj Violence Res 2007;11:58‑68.
  36. Soltani Y, Khaleghdoost Mohamadi T, Adib M, Kazemnejad E, Aghaei I, Ghanbari A. Comparing the predictive ability for mortality rates by GAP and MGAP scoring systems in multiple‑trauma patients. J Mazandaran Univ Med Sci 2018;27:118‑32.
Archives of Trauma Research
Volume 10, Issue 2
April 2021
Pages 86-91

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History

  • Receive Date: 14 September 2022
  • Accept Date: 14 September 2022

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