The prognostic value of platelet-to-lymphocyte ratio on in-hospital mortality in admitted adult traffic accident patients.

BACKGROUND: The predictive value of platelet-to-lymphocyte ratio (PLR) in acute illness is well known, but further evaluation is needed in traffic accident patients. METHODS: This retrospective observational study enrolled consecutive adult patients involved in traffic accidents who were admitted to the study hospital's emergency department during 1 year. The initial platelet and lymphocyte counts after arrival at the emergency department were the variables of interest. The primary outcome was in-hospital mortality. Data on baseline characteristics, comorbidities, and physiological and laboratory variables were collected. Multivariate Cox proportional hazard modelings were used to identify the variables independently associated with the outcome. RESULTS: A total of 1,522 traffic accident patient were screened, and 488 patients were enrolled. In all, 43 (8.8%) patients died in the hospital. The median PLR was 115.3 (interquartile range 71.3;181.8). The in-hospital mortality rate of the 1st tertile of PLR (21.5%) was significantly higher than the rates of the 2nd (2.5%) and 3rd (2.5%) tertiles. The area under the receiver operating characteristic curve of PLR for in-hospital survival was 0.82 (95% confidential interval [CI], 0.74-0.89), which was greater than that of lymphocyte count (0.72; 95% CI 0.63-0.81) and platelet count (0.67; 95% CI 0.57-0.76). The Kaplan-Meier curves showed a significant difference in survival between the tertiles (p<0.001). The Cox regression model showed that the 2nd tertile of PLR was independently associated with lower in-hospital mortality (adjusted hazard ratio 0.30; 95% CI, 0.09-0.98), compared to the 1st tertile. CONCLUSION: PLR was significantly associated with an increased risk of in-hospital mortality in admitted adult traffic accident patients.

Changes in peak expiratory flow rates using two head-tilt/chin-lift maneuver angles in young healthy conscious volunteers.

BACKGROUND: The head-tilt/chin-lift (HT/CL) maneuver is simple and routinely used to open a closed upper airway. OBJECTIVES: It has yet to be determined whether increasing the HT/CL angle further would be beneficial. METHODS: We enrolled 60 (30 males) 20-year-old conscious participants. Pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were defined as positions in which the angle between the ear-eye line and the horizontal line was 80°, 65°, and 50°, respectively. Peak exploratory flow rates (PEFRs) pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were recorded continuously at 1-minute intervals (one set). Five sets of measurements were performed (total, 15 measurements for each participant). RESULTS: We analysed 900 measurements (180 sets). The mean PEFRs pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were 348.4 ± 96.9, 366.4 ± 104.9, and 378.8 ± 111.2 L/min (percentage change compared to pre-HT/CL, 5.2% and 8.7%), respectively. Significant differences were observed among pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions in all participants, as well as in subgroup classified according to sex, and medians of height, body weight, and body mass index. CONCLUSION: Our findings suggest that a greater HT/CL angle would be beneficial, as the PEFR increased gradually. The decreasing manner in the PEFR increase with the HT/CL angle implies the existence of an angle threshold beyond which there were no further benefits in airflow, indicating a minimum in airway resistance. A HT/CL maneuver may be appropriate until locking the atlanto-occipital and cervical spine joints in extension occurs and the chest (sternal notch) begins to rise.

Change in peak expiratory flow rate after the head-tilt/chin-lift maneuver among young, healthy, and conscious volunteers.

OBJECTIVE: The head-tilt/chin-lift (HT/CL) is a simple, routinely used maneuver to open the upper airway. Changes in the peak expiratory flow rate (PEFR) before and after the HT/CL maneuver have not been evaluated among conscious volunteers who are regarded as a control cohort. METHODS: Sixty healthy 20-year-old volunteers (30 males and 30 females) were enrolled. The supine position was defined as the position at which the ear-eye line was at a 10° angle to the horizontal. The HT/CL position was defined as the position at which the ear-eye line was at a 25° angle to the horizontal. PEFR was measured using a hand-held device with the subject in the supine position (pre-PEFR) and HT/CL position (post-PEFR), respectively. One set was defined as these two measurements. Five sets of measurements were performed on each subject (300 sets). The set with the maximal and minimal difference between pre-PEFR and post-PEFR were excluded from the analysis. We used a paired t-test to compare the mean pre-PEFR and post-PEFR values for the entire group and subgroups divided by sex, height, body weight, body mass index and response status. RESULTS: Overall, 360 measurements (180 sets) were analyzed. The mean pre-PEFR and post-PEFR were 316.1±87.6 and 346.5±94.7 L/min, respectively. Further, significant differences were observed for sex, height, body weight, and body mass index. In 10 subjects, post-PEFR was lower than pre-PEFR. CONCLUSION: PEFR increased by 9.6% after the HT/CL maneuver in young conscious subjects, but some subjects showed decreased PEFR after the HT/CL maneuver.

Incidence of acute cerebral infarction or space occupying lesion among patients with isolated dizziness and the role of D-dimer.

BACKGROUND: To determine the incidence of acute cerebral infarction or space occupying lesion (SOL) among patients with isolated vertigo or dizziness (IVD) and to evaluate the role of cerebellar function test (CFT) and D-dimer to discriminate ACI/SOL and non-ACI/SOL. METHODS: A retrospective study of consecutive emergency department (ED) patients with IVD during one year was conducted. ACI was based on the diffusion-weighted magnetic resonance imaging (DW-MRI), and SOL was based on the concurrent MRI sequences. A sensitivity analysis of CFT and D-dimer was also performed. RESULTS: Among the 468 patients enrolled, 13 patients (2.8%) had ACI, 11 at cerebellum, 1 at occipital lobe, and 1 at centrum semiovale. Twenty-five patients (5.3%) had SOL. Aneurysm is most frequent (n = 7), followed by meningioma (n = 4) and venous anomaly (n = 4). In total, ACI/SOL was found in 8.1% (n = 38). Abnormal findings in finger-to-nose (FN), heel-to-shin (HTS), and rapid alternative movement (RAM) tests were significantly higher in ACI or ACI/SOL group, while gait disturbance, tandem gait abnormality, and Romberg's test were not. CFT sensitivities were low for ACI as well as for ACI/SOL, but specificities were high for ACI and ACI/SOL. D-dimer level showed a sensitivity of 100% at >0.18 mg/L for ACI and >0.15 mg/L for ACI/SOL. However, specificity was low at corresponding D-dimer level. Among the subgroup (n = 411) who did not show any abnormality in CFT, 9 patients (2.2%) had ACI, and 33 patients (8.0%) had ACI/SOL. CONCLUSION: The present study reports a clinically significant incidence of ACI/SOL among ED patients with IVD. D-dimer showed high sensitive and low specificity, while CFT showed low sensitivity and high specificity.

Incidence of bacteremia and antimicrobial resistance, and associated factors among patients transferred from long-term care hospital.

OBJECTIVE: To evaluate the prevalence of bacteremia and antimicrobial resistance, and associated factors among infectious patients transferred from long-term care hospitals (LTCHs). METHODS: Consecutive adult patients who were transferred for suspected infection from affiliated LTCH's to study hospital emergency department (ED) over a 12 month period from January to December 2016 were included retrospectively. Patients with positive blood cultures (excluding contaminants as clinically determined) were defined as primary measure and subjected to further analysis according to antimicrobial resistance pattern. The latter was categorized into 4 subgroups based on groups of antimicrobial choices for empiric choices of suspected bloodstream infections. R-Group 0: bacteria susceptible to penicillin and amoxicillin; R-Group 1: bacteria resistant to penicillin/amoxicillin, first, second, or third generation cephalosporins. R-Group 2: ESBL-producing bacteria or bacteria resistant methicillin, fourth generation cephalosporin, or fluoroquinolone. R-Group 3: highly resistant pathogens including vancomycin resistant enterococci, carbapenem or colistin resistant Gram negatives. Blood culture isolate could therefore be included in >1 group. RESULTS: Among 756 patients who were transferred from LTCHs, we excluded 278 patients who were not suspicious of infection and 65 patients who were not checked blood culture at ED. In total, 422 patients were enrolled. The incidence of bacteremia was 20.4% (n = 86). The most frequent pathogen was E. coli (n = 25) followed by S. aureus (n = 10), S. epidermidis (n = 8), and K. pneumonia (n = 6). The incidences of the R-Group 1, 2, and 3 groups were 16.8% (n = 71), 14.4% (n = 61), and 1.4% (n = 6), respectively. Of the Gram-positive pathogens (n = 44), the R-Group 1, 2, and 3 groups were 84.1% (n = 37), 75.0% (n = 33), and 9.1% (n = 4), respectively. Of the Gram-negative pathogens (n = 46), the R-Group 1, 2, and 3 groups were 82.6% (n = 38), 69.6% (n = 32), and 4.3% (n = 2), respectively. Among tested variables, initial serum procalcitonin level was significantly associated with the presence of bacteremia (AOR 1.03, 95% confidence interval 1.00-1.05), R-Group 1 (1.04, 1.01-1.07) and the R-Group 2 (1.04, 1.00-1.06). CONCLUSIONS: The prevalence of bloodstream infections in patients admitted from LTCH was high (20.4%) with majority of these infections from resistant bacteria. Procalcitonin levels were significantly higher in bacteremic patients with an increasing trend towards bacteria in the antimicrobial resistant groups.

Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding.

OBJECTIVE: We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB). METHODS: We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours. RESULTS: Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59-0.73, P=0.004), but not to GBS (0.70, 0.64-0.77, P=0.141) and AIMS65 (0.76, 0.70-0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%. CONCLUSION: The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.

Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients.

PURPOSE: The predictive value of serum albumin in adult aspiration pneumonia patients remains unknown. METHODS: Using data collected during a 3-year retrospective cohort of hospitalized adult patients with aspiration pneumonia, we evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. RESULTS: 248 Patients were enrolled; of these, 51 cases died (20.6%). The mean serum albumin level was 3.4±0.7g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (3.0±0.6g/dL vs. 3.5±0.6g/dL). In the multivariable logistic regression model, albumin was associated with in-hospital mortality significantly (adjusted odds ratio 0.30, 95% confidential interval (CI) 0.16-0.57). The area under the receiver operating characteristics (AUROC) for in-hospital survival was 0.72 (95% CI 0.64-0.80). The Youden index was 3.2g/dL and corresponding sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were 68.6%, 66.5%, 34.7%, 89.1%, 2.05 and 0.47, respectively. High sensitivity (98.0%) was shown at albumin level of 4.0g/dL and high specificity (94.9%) was shown at level of 2.5g/dL. CONCLUSION: Initial serum albumin levels were independently associated with in-hospital mortality among adult patients hospitalized with aspiration pneumonia and demonstrated fair discriminative performance in the prediction of in-hospital mortality.

Comprehensive interpretation of hyperglycemia and hyperosmolality on the clinical outcomes among ischemic stroke patients.

BACKGROUND: Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients. OBJECTIVES: We evaluated the association between hyperglycemia and hyperosmolality, as a combination measure, with poor outcome among AIS patients. METHODS: We conducted a retrospective study of AIS patients admitted to the study hospital emergency department between January and December 2014. Hyperglycemia was defined as serum glucose >144 mg/dL, and hyperosmolality was defined as a serum osmolality >295 mOsm/kg. After excluding hypoglycemia and hypoosmolality, the enrolled patients were classified into the following 4 subgroups: normoglycemia-normoosmolality, hyperglycemia-normoosmolality (HGNO), normoglycemia-hyperosmolality (NGHO), and hyperglycemia-normoosmolality (HGHO). The primary outcome was poor neurological status at 6 months, which was defined as a modified Rankin scale score ≥2. RESULTS: Six hundred seven patients were included. The primary outcome was 336 (55.4%), and it was highest in the HGNO group (69.6%, 103/148), followed by the HGHO group (67.9%, 53/78), the NGHO group (57.3%, 43/75) and the normoglycemia-normoosmolality group (44.7%, 137/306). The multivariable logistic regression analysis revealed that HGNO and HGHO remained significant factors, with primary outcomes (adjusted odds ratio, 2.08; 95% confidence interval, 1.16-3.71) and 2.93 (1.45-5.91), respectively), whereas NGHO was not a significant factor. Cases of extremely high sodium levels were few in the NGHO and HGHO groups, whereas considerable cases of extremely high glucose level were observed in the HGHO group. CONCLUSION: Hyperglycemia was associated with poor outcome, even after excluding the effect of hyperosmolality. However, hyperosmolality without hyperglycemia was not associated with poor outcome. An additive effect, likely reflecting severe hyperglycemia, was observed.

Predictive value of the National Early Warning Score-Lactate for mortality and the need for critical care among general emergency department patients.

STUDY OBJECTIVES: What is the predictive value of the National Early Warning Score-Lactate (NEWS-L) score for mortality and the need for critical care in general emergency department (ED) patients? METHODS: In this retrospective cohort study, we enrolled all adult patients who visited the ED of an urban academic tertiary-care university hospital in South Korea over 2 consecutive months. The primary outcome was 2-day mortality. The secondary outcomes were the need for critical care (advanced airway use, vasopressor or inotropic agent use, intensive care unit admission) during an ED stay; 2-day composite outcome (2-day mortality and the need for critical care); 7-day mortality; and in-hospital mortality. RESULTS: During the study period, 4624 adult patients visited the ED. Of these, 87 (1.9%) died within 2 days. In total, 481 patients (10.4%) required critical care during their ED stay. The 2-day composite outcome, 7-day mortality, and in-hospital mortality were 10.9% (503/4624), 2.5% (116/4624), and 3.9% (182/4624), respectively. The NEWS-L demonstrated excellent predictive value for 2-day mortality with an area under the receiver operating characteristic curve (AUROC) of 0.96 (95% confidence interval [CI], 0.94-0.98); this value was better than that of the NEWS alone (AUROC 0.94 [95% CI, 0.91-0.96], P=.002). The AUROC of the NEWS-L for the need for critical care was 0.83 (95% CI, 0.81-0.85); for the 2-day composite outcome, it was 0.84 (95% CI, 0.82-0.86); for 7-day mortality, it was 0.94 (95% CI, 0.92-0.96); and for in-hospital mortality, it was 0.87 (95% CI, 0.85-0.90). Logistic regression results confirmed that the ratio of the NEWS to the initial lactate level was 1:1. Similar results were obtained in the subgroup analyses (disease-infection, disease-vascular and heart, disease-others, and nondisease). The high-risk NEWS-L group (NEWS-L≥7, 9.4% of all patients) had an adjusted odds ratio of 28.67 (12.66-64.92) for 2-day mortality in the logistic regression model adjusted for basic characteristics. CONCLUSION: The NEWS-L can provide excellent discriminant value for predicting 2-day mortality in general ED patients, and it has the best discriminant value regarding the need for critical care and composite outcomes. The NEWS-L may be helpful in the early identification of at-risk general ED patients.

Diagnostic performance of initial serum lactate for predicting bacteremia in female patients with acute pyelonephritis.

OBJECTIVES: The purpose of the present study was to investigate the diagnostic value of lactate for predicting bacteremia in female patients with acute pyelonephritis (APN). METHODS: We conducted a retrospective study of female patients with APN who visited the study hospital emergency department. The demographics, comorbidities, physiologies, and laboratory variables including white blood cell count and segmented neutrophil count, C-reactive protein, and initial serum lactate levels were collected and analyzed to identify associations with the presence of bacteremia. RESULTS: During the study period, a total of 314 patients were enrolled. One hundred twenty-three patients (39.2%) had bacteremia. Escherichia coli was the most frequent pathogen. Logistic regression analysis demonstrated that the lactate level was independently associated with the presence of bacteremia (odds ratio, 1.39 [95% confidence interval, 1.08-1.78]). The C-statistic of the lactate level was 0.67 (95% CI, 0.60-0.73). At a cutoff value of 1.4mmol/L, the lactate level predicted bacteremia with a sensitivity (53.7%), specificity (72.3%), positive predictive value (55.5%), negative predictive value (70.8%), positive likelihood ratio (1.93), and negative likelihood ratio (0.64). CONCLUSION: The initial serum lactate level showed poor discriminative performance for predicting bacteremia in female patients with APN.

Validation of modified early warning score using serum lactate level in community-acquired pneumonia patients. The National Early Warning Score-Lactate score.

STUDY OBJECTIVE: The aim of this study was to investigate the prognostic prediction power of a newly introduced early warning score modified by serum lactate level, the National Early Warning Score-Lactate (NEWS-L) score, among community-acquired pneumonia (CAP) patients. We also compared the NEWS-L score with the pneumonia severity index (PSI) and CURB-65. METHODS: We designed a retrospective observational study and collected data on confirmed adult CAP patients who visited the study hospital between October 2013 and September 2014. Variables relevant to, the NEWS-L score, PSI, and CURB-65 were extracted from electronic medical records. Survival status at hospital discharge was determined in the same manner. The NEWS-L score was calculated as NEWS-L=NEWS+serum lactate level (mmol/L). The NEWS-L was divided into quartiles. The ability to predict mortality was assessed through area under the receiver operating characteristic curve analysis and calibration analysis. RESULTS: A total of 553 patients were enrolled, and the inpatient mortality rate was 10.8% (n=60). Mortality rates increased incrementally in conjunction with the NEWS-L quartiles: first quartile, 2.2%; second quartile, 7.9%; third quartile, 9.6%; and fourth quartile, 23.9%. The area under the receiver operating characteristic curve of the NEWS-L score was 0.73 (95% confidence interval [CI], 0.66-0.80), which showed no significant difference from that of the PSI (0.68; 95% CI, 0.61-0.76; P=.28) and CURB-65 (0.66; 95% CI, 0.59-0.73; P=.06). CONCLUSIONS: The newly introduced early warning score modified by serum lactate level, NEWS-L score, was comparable to PSI and CURB-65, for predicting inpatient mortality among adult CAP patients.

ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study.

BACKGROUND: Adverse effects of emergency department (ED) crowding among critically ill patients are not well known. OBJECTIVES: We evaluated the association between ED crowding and inpatient mortality among critically ill patients admitted via the ED, and analyzed subsets of patients according to admission diagnosis. METHODS: We performed a post hoc analysis using data from a previous retrospective study. We enrolled admitted patients via the ED with an initial systolic blood pressure of 90 mm Hg or lower when presenting to the ED. The ED occupancy ratio was used as a measure of crowding. The primary outcome was inpatient mortality. Multivariable logistic regression models adjusted for potential confounding variables were constructed for the entire cohort and for subsets according to admission diagnosis (infection, cardiac and vascular disease, trauma, gastrointestinal bleeding, and other factors). RESULTS: A total of 1801 patients were enrolled, with a mortality rate of 14.6% (262 patients). The mortality rate by ED occupancy ratio quartile was 9.7% for the first quartile, 15.9% for the second quartile, 18.2% for the third quartile, and 14.4% for the fourth quartile. This resulted in adjusted odds ratios of 1.95, 2.51, and 1.93 and corresponding 95% confidence intervals of 1.23-3.12, 1.58-3.99, and 1.21-3.09 for the second, third, and fourth quartiles, respectively, compared with the first quartile. The effect of ED crowding was highest in the trauma subset, followed by the infection subset, whereas ED crowding did not appear to have any effect on the cardiac and vascular disease subsets. CONCLUSION: Emergency department crowding was associated with increased inpatient mortality among critically ill patients admitted via the ED.

Initial serum lactate level is associated with inpatient mortality in patients with community-acquired pneumonia.

STUDY OBJECTIVE: The aim of the present study was to investigate the prognostic value of the initial serum lactate level in patients with community-acquired pneumonia (CAP). METHODS: We collected data on hospitalized adult patients with CAP via the study hospital emergency department between October 2012 and September 2013. Demographics, comorbidities, and physiologic and laboratory variables including initial C-reactive protein (CRP) and serum lactate level were extracted from the electronic medical record. The primary outcome was inpatient mortality. Comparisons between survivors and nonsurvivors were performed, and multivariable logistic regression analyses were constructed as dependent variables of both continuous and categorical varieties. RESULTS: A total of 397 patients were enrolled, and the mortality cases were 46 (11.6%). The mean lactate level was 1.7 ± 1.4 mmol/L and was significantly higher in the nonsurvivor group than in the survivor group (2.4 ± 2.2 mmol/L vs 1.6 ± 1.2 mmol/L). In the multivariable logistic regression model for inpatient mortality constructed using lactate, CRP, and laboratory variables of pneumonia severity index (PSI), lactate and CRP remained as significant factors, but laboratory variables of PSI were not. In other multivariable logistic regression models for the outcome constructed using collected laboratory variables and PSI, lactate remained as a significant factor (adjusted odds ratio, 1.24; 95% confidence interval, 1.01-1.53; P = .042 by continuous variable; adjusted odds ratio of third tertile, 2.60; 95% confidence interval, 1.02-6.66; P = .046 by category variable). C-reactive protein and albumin were also left as significant factors. CONCLUSIONS: The initial serum lactate level is independently associated with mortality in hospitalized patients with CAP. However, laboratory variables of PSI or others were not, except CRP and albumin.

Emergency department occupancy ratio is associated with increased early mortality.

BACKGROUND: To measure emergency department (ED) crowding, the emergency department occupancy ratio (EDOR) was introduced. OBJECTIVE: Our aim was to determine whether the EDOR is associated with mortality in adult patients who visited the study hospital ED. METHODS: We reviewed data on all patients who visited the ED of an urban tertiary academic hospital in Korea for 2 consecutive years. The EDOR is defined by the total number of patients in the ED divided by the number of licensed ED beds. We tested the association between the EDOR (quartile) and each outcome using a multivariable logistic regression analysis adjusted for potential confounders: age, sex, emergency medical services transport, transferred case, weekend visit, shift, triage acuity, visit cause of injury, operation, vital signs, intensive care unit or ward admission, and ED length of stay (quartile). The main outcome measures were survival status at discharge and at 1-7 days. RESULTS: A total of 54,410 adult patients were enrolled. The EDOR ranged from 0.41 to 2.31 and the median was 1.24. On multivariable analyses, in comparison with the lowest (first) quartile, the highest (fourth) quartile of the EDOR was associated with 1-day mortality (adjusted odds ratio [OR] = 1.42; 95% confidence interval [CI] 1.08-1.88), 2-day mortality (adjusted OR = 1.31; 95% CI 1.04-1.67), and 3-day mortality (adjusted OR = 1.27; 95% CI 1.02-1.58). The EDOR was not significantly associated with 4- to 7-day mortalities and overall mortality at discharge. CONCLUSIONS: The EDOR is associated with increased 1- to 3-day mortality even after controlling for potential confounders.

Comparison of the trauma and injury severity score and modified early warning score with rapid lactate level (the ViEWS-L score) in blunt trauma patients.

OBJECTIVE: The aim of this study was to compare the predictive value of the VitalPAC Early Warning Score-lactate (ViEWS-L) score with that of the trauma and injury severity score (TRISS), which is a pre-existing risk scoring system used in trauma patients. METHODS: The patients were blunt trauma victims admitted consecutively to the study hospital between 1 April 2010 and 31 March 2011, who were 15 years or older and had an injury severity score of 9 or higher. The lactate level, the ViEWS and revised trauma score upon arrival at the emergency department, and the injury severity score and TRISS were evaluated. The ViEWS-L score was calculated according to the formula: ViEWS-L=ViEWS+lactate (mmol/l). The ability to predict mortality was assessed by area under the receiver operating characteristic curve (AUC) analysis and calibration analysis. RESULTS: A total of 299 patients were available for analysis, of whom 33 died (11.0%). The median ViEWS-L score was 3.7 (interquartile range:1.8-6.4) and the median TRISS was 96.8 (interquartile range: 93.4-98.6). The ViEWS-L score was better than TRISS at predicting hospital mortality (AUC, 0.838; 95% confidence interval, 0.771-0.906 vs. AUC, 0.734; 95% confidence interval, 0.635-0.833, P=0.031). Calibration of the ViEWS-L score (χ=11.13, P=0.194) was good but that of TRISS was not (χ=16.97, P=0.018). CONCLUSION: The prognostic value of the ViEWS-L score in terms of discrimination was better than that of TRISS in the blunt trauma patients admitted to the emergency department with an injury severity score of 9 or higher, and the ViEWS-L score showed good calibration.