|
Abstract
|
BACKGROUND: Trauma, largely the result of motor vehicle crashes, is the leading cause of pregnancy-associated maternal mortality. Prediction of adverse outcomes has been difficult in pregnancy given the infrequent occurrence of traumatic events and anatomic considerations unique to pregnancy. The injury severity score, an anatomic scoring system with weighting dependent on severity and anatomic region of injury, is utilized for prediction of adverse outcomes in the non-pregnant population, but has yet to be validated in pregnancy.
OBJECTIVE: To estimate associations between risk factors and adverse pregnancy outcomes after major trauma in pregnancy and develop a clinical prediction model for maternal and perinatal adverse outcomes. STUDY DESIGN: A retrospective analysis of a cohort of pregnant patients who sustained major trauma at two level I trauma centers was performed. Three composite adverse pregnancy outcomes were created: adverse maternal and short- and long-term perinatal adverse outcomes, defined as occurring within the first 72 hours of the traumatic event or encompassing the entire pregnancy. Bivariate analyses were performed to estimate associations between clinical or trauma-related variables and adverse pregnancy outcomes. Multivariable logistic regression analyses were performed to predict each adverse pregnancy outcome. The predictive performance of each model was estimated using receiver operator characteristic curve analyses.
RESULTS: 119 pregnant trauma patients were included, 26.1% of which met the maternal severe adverse pregnancy outcome criteria, 29.4% who met the short-term perinatal severe adverse pregnancy outcome definition, and 51.3% who met the long-term perinatal severe adverse pregnancy outcome definition. Injury severity score (ISS) and gestational age were associated with the composite short-term perinatal adverse pregnancy outcome with an aOR 1.20 (95% CI 1.11 - 1.30). The injury severity score was solely predictive of the maternal and long-term perinatal adverse pregnancy outcomes with ORs of 1.65 (95% CI 1.31 - 2.09) and 1.14 (95% CI 1.07 - 1.23), respectively. An ISS ≥ 8 was the best cutoff for predicting adverse maternal outcomes with 96.8% sensitivity and 92.0% specificity (ROC AUC 0.990 ± 0.006). An ISS ≥ 3 was the best cutoff for the short-term perinatal adverse outcomes, which correlates to a 68.6% sensitivity and 65.1% specificity (ROC AUC 0.755 ± 0.055). An ISS ≥2 was the best cutoff for the long-term perinatal adverse outcomes, yielding a 68.3% sensitivity and 72.4% specificity (ROC AUC 0.763 ± 0.042).
CONCLUSION: For pregnant trauma patients, an injury severity score of ≥ 8 is predictive of severe maternal adverse outcomes. Minor trauma in pregnancy, defined in this study as an ISS <2, was not associated with maternal or perinatal morbidity or mortality. This data can guide management decisions for pregnant patients presenting after trauma.
Language: en |