Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 3 ( September-December, 2017 ) > List of Articles

RESEARCH ARTICLE

Evaluación de la Nueva Definición de Politrauma en una Cohorte de Pacientes de 10 Hospitales Argentinos

Enrique Ginzburg, Emilio Maciá, Cristian Barbaro, Claudio Ortiz, Ezequiel Monteverde

Citation Information : Ginzburg E, Maciá E, Barbaro C, Ortiz C, Monteverde E. Evaluación de la Nueva Definición de Politrauma en una Cohorte de Pacientes de 10 Hospitales Argentinos. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):182-189.

DOI: 10.5005/jp-journals-10030-1190

License: CC BY 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introducción

La definición de Berlin de politrauma (2014) combina la severidad lesional con al menos uno de cinco complementos (edad, TAS, GCS, KPTT o EB).

Hasta ahora hay insuficiente información sobre cómo afecta esta nueva definición la identificación de los grupos con mayor mortalidad. El objetivo de este trabajo fue evaluar la performance de esta definición comparándola con otras mediciones.

Materiales y Métodos

Análisis retrospectivo observacional de ingresos prospectivos al Registro de Trauma de Fundación Trauma en 10 hospitales entre 2010-2016. Los criterios de inclusión fueron edad > 15 años y tener información completa para el cálculo de los índices. Los pacientes se compararon según las definiciones de politrauma (PT), trauma múltiple (Tmult), trauma mayor por ISS (TM_ISS) y trauma mayor por NISS (TM_NISS). Se analizaron medidas de performance.

Resultados

Se analizaron 259 hechos con PT, 802 con Tmult, 1349 con TM_ISS y 2143 con TM_NISS. El grupo PT resultó heterogéneo, con una mortalidad entre 44% y 71% según diferentes combinaciones de complementos. El 75% tuvo lesiones por transporte y el 76% tuvo al menos una lesión encefálica AIS > 2. El desenlace estuvo relacionado con el estado al ingreso, por impacto fisiológico (RTS) y por severidad lesional (ISS-NISS). La relación O/E para sobrevida por TRISS fue 0.73.

La comparación con las otras definiciones mostró diferencias estadísticamente significativas en mortalidad pero no en ISS, NISS ni RTS. La evaluación de performance mostró que TM_NISS tuvo la mayor sensibilidad y el mayor VPN, mientras que PT tuvo el mayor VPP. Como medida global, TM_ISS tuvo una precisión superior al resto (89%) y una especificidad de 97%.

Conclusiones

La definición de PT para identificación de pacientes con mayor riesgo de muerte no mostró ser superior a otras definiciones de uso corriente. Consideramos que la definición de PT necesita ser validada en estudios multicéntricos antes de recomendarse como un nuevo standard.

How to cite this article

Monteverde E, Bosque L, Lartigue B, Maciá E, Barbaro C, Ortiz C, Ginzburg E, Neira J. Evaluación de la Nueva Definición de Politrauma en una Cohorte de Pacientes de 10 Hospitales Argentinos. Panam J Trauma Crit Care Emerg Surg 2017;6(3):182-189.

Introduction

Berlin definition of polytrauma from 2014 combines injury severity with at least one of five ancillary parameters (age, systolic blood pressure, Glasgow coma score, coagulopathy and acidosis). Until now there is insufficient evidence of this definition's capability to identify higher risk of mortality patients. The objective of this investigation was to evaluate this definition's performance to identify severely injured patients as compared with other current measures.

Materials and methods

Retrospective observational analysis was done on prospectively admitted patients to Fundación Trauma Registry in 10 Argentine hospitals between 2010 and 2016. The inclusion criteria were age > 15 years and complete data for scores calculation. Patients were compared across four definitions: polytrauma, multiple trauma (MulT), major trauma by major trauma_injury severity score (MT_ISS), and by major trauma_new injury severity score (MT_NISS). Performance measures were applied.

Results

We identified 2143 cases meeting MT_NISS definition, 1349 for MT_ISS, 802 for MulT and 259 for polytrauma. Polytrauma group was heterogenous, with a mortality rate ranging from 44% to 71% (resulting from different component combinations). About 75% were transport-injured and 76% had at least one AIS3+ head injury. Hospital outcome was related to condition at admission, physiologic impact revised trauma score (RTS) and injury severity (ISS-NISS). Observed to predicted survival ratio method trauma and injury severity score (TRISS) was 0.73. The comparison with the other definitions showed statistically significant differences in mortality but not in ISS, NISS, and RTS. Performance evaluation showed that MT_NISS had the highest sensibility and negative predictive value and polytrauma had the highest predictive value (PPV). MT_ISS had the highest precision (89%) and a specificity of 97%.

Conclusion

Polytrauma definition used to identify patients with the highest probability of death did not show any benefit when compared with other current measures. We consider that this definition needs to be validated in multicentric studies before being recommended as a new standard.


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