Prediction of intra-hospital mortality after severe trauma: Which pre-hospital score is the most accurate?

Pierre Bouzat, Robin Legrand, Pierre Gillois, François Xavier Ageron, Julien Brun, Dominique Savary, Frédéric Champly, Pierre Albaladejo, Jean François Payen

Research output: Contribution to journalArticle

Abstract

Purpose Computing trauma scores in the field allows immediate severity assessment for appropriate triage. Two pre-hospital scores can be useful in this context: the Triage-Revised Trauma Score (T-RTS) and the Mechanism, Glasgow, Age and arterial Pressure (MGAP) score. The Trauma Revised Injury Severity Score (TRISS), not applicable in the pre-hospital setting, is the reference score to predict in-hospital mortality after severe trauma. The aim of this study was to compare T-RTS, MGAP and TRISS in a cohort of consecutive patients admitted in the Trauma system of the Northern French Alps(TRENAU). Materials and methods From 2009 to 2011, 3260 patients with suspected severe trauma according to the Vittel criteria were included in the TRENAU registry. All data necessary to compute T-RTS, MGAP and TRISS were collected in patients admitted to one level-I, two level-II and ten level-III trauma centers. The primary endpoint was death from any cause during hospital stay. Discriminative power of each score to predict mortality was measured using receiver operating curve (ROC) analysis. To test the relevancy of each score for triage, we also tested their sensitivity at usual cut-offs. We expected a sensitivity higher than 95% to limit undertriage. Results The TRISS score showed the highest area under the ROC curve (0.95 [CI 95% 0.94-0.97], p <0.01). Pre-hospital MGAP score had significantly higher AUC compared to T-RTS (0.93 [CI 95% 0.91-0.95] vs 0.86 [CI 95% 0.83-0.89], respectively, p <0.01). MGAP score <23 had a sensitivity of 88% to detect mortality. Sensitivities of T-RTS <12 and TRISS <0.91 were 79% and 87%, respectively. Discussion/conclusion Pre-hospital calculation of the MGAP score appeared superior to T-RTS score in predicting intra-hospital mortality in a cohort of trauma patients. Although TRISS had the highest AUC, this score can only be available after hospital admission. These findings suggest that the MGAP score could be of interest in the pre-hospital setting to assess patients' severity. However, its lack of sensitivity indicates that MGAP should not replace the decision scheme to direct the most severe patients to level-I trauma center.

Original languageEnglish (US)
Pages (from-to)14-18
Number of pages5
JournalInjury
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Hospital Mortality
Wounds and Injuries
Triage
Injury Severity Score
Arterial Pressure
Trauma Centers
Area Under Curve
Mortality
Registries

Keywords

  • Mortality
  • Severe trauma
  • Trauma scores

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Bouzat, P., Legrand, R., Gillois, P., Ageron, F. X., Brun, J., Savary, D., ... Payen, J. F. (2016). Prediction of intra-hospital mortality after severe trauma: Which pre-hospital score is the most accurate? Injury, 47(1), 14-18. https://doi.org/10.1016/j.injury.2015.10.035

Prediction of intra-hospital mortality after severe trauma : Which pre-hospital score is the most accurate? / Bouzat, Pierre; Legrand, Robin; Gillois, Pierre; Ageron, François Xavier; Brun, Julien; Savary, Dominique; Champly, Frédéric; Albaladejo, Pierre; Payen, Jean François.

In: Injury, Vol. 47, No. 1, 01.01.2016, p. 14-18.

Research output: Contribution to journalArticle

Bouzat, P, Legrand, R, Gillois, P, Ageron, FX, Brun, J, Savary, D, Champly, F, Albaladejo, P & Payen, JF 2016, 'Prediction of intra-hospital mortality after severe trauma: Which pre-hospital score is the most accurate?', Injury, vol. 47, no. 1, pp. 14-18. https://doi.org/10.1016/j.injury.2015.10.035
Bouzat, Pierre ; Legrand, Robin ; Gillois, Pierre ; Ageron, François Xavier ; Brun, Julien ; Savary, Dominique ; Champly, Frédéric ; Albaladejo, Pierre ; Payen, Jean François. / Prediction of intra-hospital mortality after severe trauma : Which pre-hospital score is the most accurate?. In: Injury. 2016 ; Vol. 47, No. 1. pp. 14-18.
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abstract = "Purpose Computing trauma scores in the field allows immediate severity assessment for appropriate triage. Two pre-hospital scores can be useful in this context: the Triage-Revised Trauma Score (T-RTS) and the Mechanism, Glasgow, Age and arterial Pressure (MGAP) score. The Trauma Revised Injury Severity Score (TRISS), not applicable in the pre-hospital setting, is the reference score to predict in-hospital mortality after severe trauma. The aim of this study was to compare T-RTS, MGAP and TRISS in a cohort of consecutive patients admitted in the Trauma system of the Northern French Alps(TRENAU). Materials and methods From 2009 to 2011, 3260 patients with suspected severe trauma according to the Vittel criteria were included in the TRENAU registry. All data necessary to compute T-RTS, MGAP and TRISS were collected in patients admitted to one level-I, two level-II and ten level-III trauma centers. The primary endpoint was death from any cause during hospital stay. Discriminative power of each score to predict mortality was measured using receiver operating curve (ROC) analysis. To test the relevancy of each score for triage, we also tested their sensitivity at usual cut-offs. We expected a sensitivity higher than 95{\%} to limit undertriage. Results The TRISS score showed the highest area under the ROC curve (0.95 [CI 95{\%} 0.94-0.97], p <0.01). Pre-hospital MGAP score had significantly higher AUC compared to T-RTS (0.93 [CI 95{\%} 0.91-0.95] vs 0.86 [CI 95{\%} 0.83-0.89], respectively, p <0.01). MGAP score <23 had a sensitivity of 88{\%} to detect mortality. Sensitivities of T-RTS <12 and TRISS <0.91 were 79{\%} and 87{\%}, respectively. Discussion/conclusion Pre-hospital calculation of the MGAP score appeared superior to T-RTS score in predicting intra-hospital mortality in a cohort of trauma patients. Although TRISS had the highest AUC, this score can only be available after hospital admission. These findings suggest that the MGAP score could be of interest in the pre-hospital setting to assess patients' severity. However, its lack of sensitivity indicates that MGAP should not replace the decision scheme to direct the most severe patients to level-I trauma center.",
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AU - Gillois, Pierre

AU - Ageron, François Xavier

AU - Brun, Julien

AU - Savary, Dominique

AU - Champly, Frédéric

AU - Albaladejo, Pierre

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N2 - Purpose Computing trauma scores in the field allows immediate severity assessment for appropriate triage. Two pre-hospital scores can be useful in this context: the Triage-Revised Trauma Score (T-RTS) and the Mechanism, Glasgow, Age and arterial Pressure (MGAP) score. The Trauma Revised Injury Severity Score (TRISS), not applicable in the pre-hospital setting, is the reference score to predict in-hospital mortality after severe trauma. The aim of this study was to compare T-RTS, MGAP and TRISS in a cohort of consecutive patients admitted in the Trauma system of the Northern French Alps(TRENAU). Materials and methods From 2009 to 2011, 3260 patients with suspected severe trauma according to the Vittel criteria were included in the TRENAU registry. All data necessary to compute T-RTS, MGAP and TRISS were collected in patients admitted to one level-I, two level-II and ten level-III trauma centers. The primary endpoint was death from any cause during hospital stay. Discriminative power of each score to predict mortality was measured using receiver operating curve (ROC) analysis. To test the relevancy of each score for triage, we also tested their sensitivity at usual cut-offs. We expected a sensitivity higher than 95% to limit undertriage. Results The TRISS score showed the highest area under the ROC curve (0.95 [CI 95% 0.94-0.97], p <0.01). Pre-hospital MGAP score had significantly higher AUC compared to T-RTS (0.93 [CI 95% 0.91-0.95] vs 0.86 [CI 95% 0.83-0.89], respectively, p <0.01). MGAP score <23 had a sensitivity of 88% to detect mortality. Sensitivities of T-RTS <12 and TRISS <0.91 were 79% and 87%, respectively. Discussion/conclusion Pre-hospital calculation of the MGAP score appeared superior to T-RTS score in predicting intra-hospital mortality in a cohort of trauma patients. Although TRISS had the highest AUC, this score can only be available after hospital admission. These findings suggest that the MGAP score could be of interest in the pre-hospital setting to assess patients' severity. However, its lack of sensitivity indicates that MGAP should not replace the decision scheme to direct the most severe patients to level-I trauma center.

AB - Purpose Computing trauma scores in the field allows immediate severity assessment for appropriate triage. Two pre-hospital scores can be useful in this context: the Triage-Revised Trauma Score (T-RTS) and the Mechanism, Glasgow, Age and arterial Pressure (MGAP) score. The Trauma Revised Injury Severity Score (TRISS), not applicable in the pre-hospital setting, is the reference score to predict in-hospital mortality after severe trauma. The aim of this study was to compare T-RTS, MGAP and TRISS in a cohort of consecutive patients admitted in the Trauma system of the Northern French Alps(TRENAU). Materials and methods From 2009 to 2011, 3260 patients with suspected severe trauma according to the Vittel criteria were included in the TRENAU registry. All data necessary to compute T-RTS, MGAP and TRISS were collected in patients admitted to one level-I, two level-II and ten level-III trauma centers. The primary endpoint was death from any cause during hospital stay. Discriminative power of each score to predict mortality was measured using receiver operating curve (ROC) analysis. To test the relevancy of each score for triage, we also tested their sensitivity at usual cut-offs. We expected a sensitivity higher than 95% to limit undertriage. Results The TRISS score showed the highest area under the ROC curve (0.95 [CI 95% 0.94-0.97], p <0.01). Pre-hospital MGAP score had significantly higher AUC compared to T-RTS (0.93 [CI 95% 0.91-0.95] vs 0.86 [CI 95% 0.83-0.89], respectively, p <0.01). MGAP score <23 had a sensitivity of 88% to detect mortality. Sensitivities of T-RTS <12 and TRISS <0.91 were 79% and 87%, respectively. Discussion/conclusion Pre-hospital calculation of the MGAP score appeared superior to T-RTS score in predicting intra-hospital mortality in a cohort of trauma patients. Although TRISS had the highest AUC, this score can only be available after hospital admission. These findings suggest that the MGAP score could be of interest in the pre-hospital setting to assess patients' severity. However, its lack of sensitivity indicates that MGAP should not replace the decision scheme to direct the most severe patients to level-I trauma center.

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