Citation

Lichtveld RA, Spijkers ATE, Hoogendoorn JM, Panhuizen IF, Van der Werken C. Int. J. Emerg. Med. 2008; 1(1): 21-26.

Affiliation

Department of Ophthalmology, Stichting Regionale Ambulance Voorziening Provincie Utrecht, Postbus 574, 3720 AN, Bilthoven, Netherlands, r.lichtveld@ravu.nl.

Copyright

(Copyright © 2008, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s12245-008-0013-7

PMID

19384497

PMCID

PMC2536180

Abstract

OBJECTIVE: To assess among seriously injured accident victims whether change of the Triage Revised Trauma Score (T-RTS) between first assessment and arrival at the hospital independently predicts mortality. DESIGN: Prospective cohort study. METHODS: The study analysed data on 507 trauma patients with multiple injuries and with a Hospital Trauma Index-Injury Severity Score (HTI-ISS) of 16 or higher, who were presented directly by ambulance services to the Accident & Emergency Department of the University Medical Centre Utrecht (the Netherlands) in 1999 and 2000. RESULTS: Compared to non-intubated patients whose T-RTS remained unchanged (reference category), the mortality risk was 3.1 times higher [95% confidence interval (CI): 1.5-6.3, p = 0.001] for patients with deteriorating T-RTS, 2.9 times higher (95% CI: 1.3-6.5, p < 0.001) for patients who had an initially good T-RTS but were nevertheless intubated and 5.7 times higher (95% CI: 3.6-9.0, p < 0.001) for patients who had an initially poor T-RTS and were intubated. These associations were independent of factors that could be assumed to have a direct effect on T-RTS, that is intravenous therapy, oxygen administration and being attended to by a mobile medical team at the scene of the accident. Along with T-RTS change, more advanced age was associated with a higher mortality risk. CONCLUSION: Intubation and a deteriorating T-RTS between the time of the accident and patient's arrival at the hospital are powerful independent predictors of mortality after hospitalisation. Together with advanced age, a deteriorating T-RTS should be the main aspect guiding the preclinical procedures.

Language: en