Trauma models to identify major trauma and mortality in the prehospital setting
| Autor: | Eveline J. A. Wiegers, H.F. Lingsma, Deanne N. Den Hartog, Charlie A. Sewalt, Stephanie C. E. Schuit, Ewout W. Steyerberg, Fiona Lecky, Esmee Venema |
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| Přispěvatelé: | Public Health, Neurology, Emergency Medicine, Internal Medicine, Surgery |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Emergency Medical Services medicine.medical_specialty Poison control Blood Pressure 030230 surgery Risk Assessment Occupational safety and health 03 medical and health sciences Injury Severity Score 0302 clinical medicine Trauma Centers Injury prevention Emergency medical services Humans Medicine Glasgow Coma Scale Hospital Mortality General Aged Aged 80 and over Models Statistical business.industry Major trauma Age Factors Reproducibility of Results 030208 emergency & critical care medicine Original Articles Middle Aged Prognosis medicine.disease Emergency medicine Wounds and Injuries Original Article Female Surgery business Risk assessment |
| Zdroj: | British Journal of Surgery, 107, 373-380. John Wiley & Sons Ltd. The British Journal of Surgery British Journal of Surgery |
| ISSN: | 1365-2168 0007-1323 |
| Popis: | Background Patients with major trauma might benefit from treatment in a trauma centre, but early identification of major trauma (Injury Severity Score (ISS) over 15) remains difficult. The aim of this study was to undertake an external validation of existing prognostic models for injured patients to assess their ability to predict mortality and major trauma in the prehospital setting. Methods Prognostic models were identified through a systematic literature search up to October 2017. Injured patients transported by Emergency Medical Services to an English hospital from the Trauma Audit and Research Network between 2013 and 2016 were included. Outcome measures were major trauma (ISS over 15) and in‐hospital mortality. The performance of the models was assessed in terms of discrimination (concordance index, C‐statistic) and net benefit to assess the clinical usefulness. Results A total of 154 476 patients were included to validate six previously proposed prediction models. Discriminative ability ranged from a C‐statistic value of 0·602 (95 per cent c.i. 0·596 to 0·608) for the Mechanism, Glasgow Coma Scale, Age and Arterial Pressure model to 0·793 (0·789 to 0·797) for the modified Rapid Emergency Medicine Score (mREMS) in predicting in‐hospital mortality (11 882 patients). Major trauma was identified in 52 818 patients, with discrimination from a C‐statistic value of 0·589 (0·586 to 0·592) for mREMS to 0·735 (0·733 to 0·737) for the Kampala Trauma Score in predicting major trauma. None of the prediction models met acceptable undertriage and overtriage rates. Conclusion Currently available prehospital trauma models perform reasonably in predicting in‐hospital mortality, but are inadequate in identifying patients with major trauma. Future research should focus on which patients would benefit from treatment in a major trauma centre. Currently available prehospital trauma models perform reasonably in predicting in‐hospital mortality, but are inadequate at identifying patients who have experienced major trauma. Future research should focus on which patients would benefit from treatment in a major trauma centre. TP, true‐positive; FP, false‐positive; MGAP, Mechanism, Glasgow Coma Scale, Age and Arterial Pressure; PSS, Physiologic Severity Score; T‐RTS, Triage Revised Trauma Score; PHI, Prehospital Index; mREMS, modified Rapid Emergency Medicine Score; KTS, Kampala Trauma Score. Useful in predicting mortality but not major trauma |
| Databáze: | OpenAIRE |
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