Optimal Prospective Predictors of Mortality in Austere Environments
| Autor: | Daniel Lammers, Kaitlin Morte, Jason Bingham, Matthew J. Martin, Matthew J. Eckert, Chris Marenco, Jeffrey R. Conner |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Warfare medicine.medical_specialty Vital signs Middle East 03 medical and health sciences 0302 clinical medicine medicine Humans Retrospective Studies Trauma Severity Indices Receiver operating characteristic business.industry Glasgow Coma Scale Emergency department Revised Trauma Score Relief Work Shock index Military Personnel 030220 oncology & carcinogenesis Emergency medicine Wounds and Injuries Injury Severity Score Female 030211 gastroenterology & hepatology Surgery Risk assessment business |
| Zdroj: | Journal of Surgical Research. 255:297-303 |
| ISSN: | 0022-4804 |
| Popis: | Background Prospective predictors of trauma-related outcomes have been validated to guide management in low-resource settings. The primary objective of this study was to determine the optimal prospective prediction method for mortality within combat and humanitarian trauma. Materials and methods Retrospective review of the Department of Defense Trauma Registry from 2008 to 2016 was performed for adult patients. Areas under receiver operating characteristic curves (AUROCs) were calculated to assess the predictability of shock index (SI), reverse SI × Glasgow Coma Scale (rSIG), SI × Glasgow Coma Scale (SIG), Revised Trauma Score, and Trauma and Injury Severity Score (TRISS) on mortality at point of injury, arrival in emergency department (ED), and the difference in vital signs between those time points. Results A total of 22,218 patients were included. Overall, 97.1% were male, median age range 25-29 y, Injury Severity Score 9.4 ± 0.07, with predominantly penetrating injuries (58.1%), and mortality of 3.4%. ED vitals yielded higher predictability of mortality for all tests based on higher AUROCs. TRISS and rSIG demonstrated the highest AUROCs (0.955 and 0.923, respectively). The optimal cutoff value for rSIG was 14.1 (sensitivity 89% and specificity 87%). rSIG values Conclusions Initial ED vital signs represented a better predictor of early mortality compared with point of injury vital signs for all predictive tools assessed. TRISS and rSIG proved to be most predictive of mortality. However, of the prospective tools assessed, rSIG may be optimal scoring tool because of its ease of calculation and its increased ability to predict mortality. |
| Databáze: | OpenAIRE |
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