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Citation
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Chun M, Zhang Y, Becnel C, Brown T, Hussein M, Toraih E, Taghavi S, Guidry C, Duchesne J, Schroll R, McGrew P. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Trauma scores are used to give clinicians appropriate quantitative context in making decisions. Studies show that anatomical trauma scores predicted intensive care unit admission better while physiological trauma scores predicted mortality better. We hypothesize that trauma scores have a hierarchy of efficacies at predicting mortality and operative decision making.
METHODS: We performed a retrospective analysis of our trauma patient database at a Level 1 Trauma center from 2016 to 2020 and calculated the following trauma scores: Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), Injury Severity Score (ISS), Shock Index (SI), and NISS. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of trauma scores for predicting mortality.
RESULTS: A total of 738 patients were included (mean age: 35.7 ± 15.6 years). AUC results from the DeLong test showed that NISS predicted mortality the best compared to other trauma scores. NISS was superior in predicting mortality for penetrating trauma (AUC = 0.86 ± 0.02, p < 0.001) compared to blunt trauma (AUC = 0.73 ± 0.04, p < 0.001). TRISS was the best predictor of mortality for patients with gunshot wounds (AUC = 0.83, 95% CI: 0.73-0.92, p < 0.001), motor vehicle accidents (AUC = 0.80, 95% CI: 0.61-1.00, p = 0.01), and falls (AUC = 0.73, 95% CI: 0.61-0.85, p = 0.007).
CONCLUSIONS: NISS was the best scoring index for predicting mortality in trauma patients, especially for penetrating trauma. Clinicians should consider incorporating other trauma scores, especially NISS and TRISS, in determining injury severity and the likelihood of mortality. These scores can help physicians determine the best course of action in patient management.
LEVEL OF EVIDENCE: Evidence Level IV.
Language: en |