Prognostic value of scoring tools in severe trauma patients admitted to the emergency department.

BACKGROUND: Severe Trauma is a misleading cause of death in young people. Early assessment of prognosis is the cornerstone in the management of such patients. Several prognostic scores have been proposed during the last decade. AIM: To evaluate the prognostic performance of trauma scores in terms of mortality in severe trauma patients admitted to the emergency department. METHODS: This was a prospective, observational and prognostic study with inclusion of severe trauma patients admitted to the emergency department over a 20 months period. We focused on the predictive value of 4 trauma scores in terms of mortality in severe trauma admitted to the resuscitation room. Four scores were included: ISS, NISS, EMTRAS and GAP score. Univariate and multivariate analysis of mortality at the 30th post-traumatic day were conducted with comparison of ROC curves of the scores. Moreover, Correlation between the several scores was studied. RESULTS: We included 298 patients. The median age was 40 (15-90) years. The sex ratio was 4,5. Clinical characteristics were n (%): GCS ≤ 8: 62 (21); PAS <90 mm Hg: 32 (11) and pulse oximetry <90%: 44 (15). The median ISS was 17 (1-75) and 176 (59%) trauma patients had a score ISS ≥ 16. The median NISS was 22 (1-75). The median EMTRAS was 3 (0-9). The median GAP was 21 (3-26). The global mortality was 21.5%. Independent predictors of mortality were: EMTRAS score ≥ 3 (adjusted OR 1.80, 95% CI [1.05-3.08], p = 0.0033), ISS ≥ 16 (adjusted OR 2.05; 95% CI [1.26-3.46], p = 0.002), GAP <20 (adjusted OR 1.92, 95% CI [1.268-2.92], p = 0.002) 1.74, 95% CI [1.17-2.592], p = 0.005). The GAP score had the best AUC= 0.811 followed by the EMTRAS with an AUC of 0.789. Finally, all the scores were strongly correlated. CONCLUSION: Severe trauma is a dynamic process with a heavy morbidity and mortality. In our study, physiological scores and combined score were correlated with prognosis as well as anatomical scores and could be proposed for early gravity assessment in severe trauma enhancing triage, management and prognosis of polytrauma patients.

Base Excess usefulness for prediction of immediate mortality in severe trauma patients admitted to the Emergency department.

BACKGROUND: Trauma is a leading cause of death in young people and hemorrhagic shock is a leading mechanism of this mortality. Hypoperfusion can be difficult to diagnose clinically, especially in younger patients. Arterial Base Excess (BE) has been used as an early indicator of hypoperfusion. AIM: To evaluate the prognostic value of admission BE in severe trauma patients admitted to the emergency department (ED). METHODS: In this prospective study, severe trauma patients meeting high velocity criteria admitted to the ED during the study period were included. BE was calculated from arterial blood gas samples. Multivariate analysis was performed for Day-1 and Day-7 post trauma mortality. ROC characteristics and survival curves were used. RESULTS: We included 479 patients. Median age was 37 (18-90). Eighty-one per cent were male. Clinical characteristics n(%): GCS<13: 170(35); SBP<90 mmHg: 64(13) and SpO2 <90%: 82(17). Mean ISS was 22 ± 13. Mortality was at days 1 and 7: 2.2% and 27.3%, respectively. Median BE was -3.2 mmol/l (-25; 28). Forty-five per cent had a BE ≤ -3.5 mmol/l. In multivariate analysis, initial BE ≤ -6.5 mmol/l was predictive of first day mortality with an Odds Ratio; [CI95%] = 3.17; [1.4-7.1]; p=0.005. Similar results were found at Day 7: Odds Ratio; [CI95%] = 1.5; [1.14-1.96]; p=0.003. BE showed high prognostic value for both mortality rates. Survival curve was significant for BE> -6.5mmol/l. CONCLUSION: in this study, a high BE above 6.5mmol/L showed a significant prognostic value in immediate and early mortality and is proposed as a marker of injury severity in trauma patients admitted to the ED. Prediction was better for the immediate mortality and thus could be proposed as a triage tool in the ED.