Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

Danilo M Razente; Bruno D Alvarez; Daniel AM Lacerda; João MDS Biscardi; Marcia Olandoski; Luiz CV Bahten

doi:10.5005/jp-journals-10030-1187

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Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

Danilo M Razente, Bruno D Alvarez, Daniel AM Lacerda, João MDS Biscardi, Marcia Olandoski, Luiz CV Bahten

Citation Information : Razente DM, Alvarez BD, Lacerda DA, Biscardi JM, Olandoski M, Bahten LC. Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):160-168.

DOI: 10.5005/jp-journals-10030-1187

License: NA

Published Online: 04-12-2017

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Abstract

Background

This study aims to compare mortality prediction capabilities of three different physiological trauma scoring systems (TSS): Revised Trauma Score (RTS) Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) and Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP).

Study design

A descriptive, cross-sectional study of trauma victims admitted to the emergency service between December-2013 and February-2014. Clinical and epidemiological information were gathered at admission and three TSS were calculated: RTS, GAP, and MGAP. The follow-up period to assess length of hospitalization and mortality lasted until August-2014. Two groups were created — survivals (S) and deaths (D) — and compared. P < 0.05 was considered statistically significant.

Results

A total of 668 trauma victims were analyzed. The mean age was 37 ± 18 and 69.8% were males. Blunt trauma prevailed (90.6%). The mean scores of RTS, GAP, and MGAP for group S (n = 657; 98.4%) were 7.77 ± 0.33, 22.8 ± 1.7, and 27.4 ± 2.3 respectively (p < 0.001), whereas group D (n = 11, 1.6%) achieved mean scores of 4.57 ± 2.95, 13 ± 7, and 15.5 ± 7 (p < 0.001). Regarding the Receiver Operating Characteristics (ROC) analysis, the areas under the curve were 0.926 (RTS), 0.941 (GAP), and 0.981 (MGAP). The three TSS demonstrated significant mortality prediction capabilities (p < 0.001). There was no statistically significant difference between the three ROC curves (p = 0.138). The MGAP achieved the highest sensitivity (100%), while GAP and RTS sensitivities were 81.8% (59—100%), and 90.9% (73.9—100%) respectively (p < 0.001). The observed specificities were 96.2% (94.77—97.7%) for GAP, 91.6% (89.5—93.7%) for MGAP, and 87.2% (84.7—89.8%) for RTS (p < 0.001). Age (p = 0.049), Glasgow Coma Scale (GCS) (p < 0.001), and trauma mechanism (p < 0.001) were different between the two groups.

Conclusion

Most patients were young males and victims of blunt trauma. The three TSS demonstrated reliability regarding mortality prediction. The MGAP achieved the highest sensitivity and GAP was the most specific score, which may indicate a potential use of both as valuable alternatives to RTS.

How to cite this article

Razente DM, Alvarez BD, Lacerda DAM, Biscardi JMDS, Olandoski M, Bahten LCV. Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems. Panam J Trauma Crit Care Emerg Surg 2017;6(3):160-168.

Objetivo

Avaliar o poder preditivo de mortalidade de três scores de trauma (ST): Score de trauma revisado (RTS); escala de coma de Glasgow, idade e pressão arterial (GAP); e mecanismo, escala de coma de Glasgow, idade e pressão arterial (MGAP).

Materiais e Métodos

Estudo transversal e descritivo envolvendo vítimas de trauma admitidas no serviço de emergência entre Dezembro-2013 e Fevereiro-2014. Informações clínicas e epidemiológicas foram coletadas na admissão e três ST foram calculados: RTS, GAP e MGAP. Houve seguimento até Agosto-2014 para avaliar tempo de hospitalização e mortalidade. Dois grupos foram criados — sobreviventes (S) e óbitos (O) - e comparados. Significância estatística adotada: p < 0,05.

Resultados

Analisaram-se 668 vítimas de trauma. Registrou-se média de idade de 37±18 anos, 69,8% sendo masculinos. Predominou o trauma contuso (90,6%). Para o grupo S (n = 657; 98,4%), as médias de RTS, GAP e MGAP foram, respectivamente, 7,77 ± 0,33, 22,8 ± 1,7 e 27,4 ± 2,3 (p < 0,001), enquanto o grupo O (n = 11, 1,6%) obteve médias de 4,57 ± 2,95, 13 ± 7 e 15,5 ± 7 (p < 0,001). A análise Receiver Operating Characteristics (ROC) revelou áreas abaixo da curva de 0,926 (RTS), 0,941 (GAP) e 0,981 (MGAP) (p<0,001). Todos os ST revelaram significativo poder preditivo de óbito (p < 0,001). As três curvas ROC não foram significativamente diferentes entre si (p = 0,138). MGAP atingiu a maior sensibilidade (100%), enquanto GAP e RTS obtiveram sensibilidades de 81,8% (59-100%) e 90,9% (73,9-100%). As especificidades foram de 96,2% (94,7-97,7%) para o GAP, 91,6% (89,5-93,7%) para o MGAP e 87,2% (84,7-89,8%) para o RTS. Idade (p = 0,049), escala de coma de Glasgow (p < 0,001) e mecanismo de trauma (p < 0,001) foram significativamente diferentes entre os dois grupos.

Conclusão

Observou-se predomínio de jovens masculinos, vítimas de trauma contuso. Os três ST demonstraram confiabilidade quanto à predição de óbito. MGAP atingiu a maior sensibilidade e GAP mostrou-se o mais específico, possivelmente indicando o uso de ambos como alternativas ao RTS.

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