[Comparison of Trauma Triage System in Prehospital Care Based on the Clinical Parameters with the ISS Score in Severely Injured Patients in the Czech Republic]. / Porovnání traumatologického triázního systému v prednemocnicní péci zalozeného na klinických parametrech s ISS skóre u tezce zranených pacientu v Ceské republice.

PURPOSE OF THE STUDY The purpose of the study is to verify the sensitivity of pre-hospital triage algorithm used in the Czech Republic, which decides on directing the patients at risk of a failure of vital functions into a trauma centre. Another aim is to find out whether the triage algorithm extension by items F4-persistent traumatic paralysis and M7-buried under heavy objects, implemented in 2015, resulted in an increased sensitivity of triage. MATERIAL AND METHODS It is a retrospective, observational, monocentric study. Included in the study were all the trauma patients with the National Advisory Committee on Aeronautics (NACA) score 3-6 treated in the given period, directed by the emergency medical service to the trauma centre. Two groups of patients were compared. In the first group, triage was performed in line with the Bulletin of the Ministry of Health of 2008, while in the second group it was performed in line with the updated version published in the Bulletin of the Ministry of Health in 2015. Both the groups were later compared with the Injury Severity Score (ISS) obtained after the diagnosis of injury in the Trauma Centre of the University Hospital Ostrava. In the second group, also certain selected parameters were assessed. Group A: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2013 to 31 December 2014 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2008. Group B: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2016 to 31 December 2017 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2015. In Group B, also monitored was the number of patients identified as triage positive only based on F4 and M7. RESULTS The first group included 3,475 patients, of whom 435 were triage positive. In the respective period, the Trauma Centre of the University Hospital Ostrava identified 262 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 210 patients. 19.9% were false negative (52/262). The mean ISS was 33.1±9.4, median 34, IQR 25.5--1. In Group A, the sensitivity of triage criteria reached 80.2% (95% IS: 74.7-84.7%), the specificity was 93.0% (95% IS: 92.0-93.8%). The second group included 3,816 patients, of whom 586 were triage positive. In the monitored period, the Trauma Centre of the University Hospital Ostrava identified 363 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 313 patients. 13.8% were false negative (50/363). The mean ISS was 43.7±12.0, median 42, IQR 33-54. In Group B, the sensitivity of triage criteria reached 86.2% (95% IS: 82.1-89.5%), the specificity was 98.5% (95% IS: 97.9-98.8%). In Group B, 11 patients were identified as triage positive based on F4 and M7 items. No statistically significant difference was found (chi-squared test, p = 0.257) after adding the F4 and M7 items to the algorithm. CONCLUSIONS The triage system for pre-hospital care in the Czech Republic in line with the applicable pre-hospital triage has high sensitivity as well as specificity and the results correspond to the latest triage algorithms used abroad. Increased sensitivity as a result of adding the new triage items was not confirmed. Key words: pre-hospital triage.

Physiologic risk factors for early acute kidney injury in severely injured patients.

BACKGROUND: The evaluation of the predictive value of the neutrophil gelatinase-associated lipocalin (NGAL) for an early acute kidney injury (AKI) development in severely injured patients. Determination of the time-dependent roles of trauma-related physiologic markers of tissue hypoxia, systemic inflammation and rhabdomyolysis in AKI development. METHODS: 81 adult patients were screened for the presence of AKI for eight consecutive days following the injury. Arterial levels of plasma NGAL, lactate, interleukin-6, procalcitonin, and myoglobin were investigated at 24 hours (T1), 48 hours (T2), and 96 hours (T3) after the injury. RESULTS: The incidence of AKI was 32.1 %. Patients with AKI were older, but no significant difference in injury severity was observed. NGAL levels were significantly higher in the AKI group at T1, T2, and T3 when compared to the non-AKI group. Lactate levels were significantly higher in the AKI group at T2 only, and IL-6 levels were significantly higher in the AKI group at T2 and T3. Procalcitonin and myoglobin levels were significantly higher in the AKI group at T1, T2, and T3, when compared to the non-AKI group. Positive correlations were found between plasma NGAL and all screened physiological factors at all defined time points. CONCLUSION: Development of AKI after blunt trauma is very complex and multifactorial. Activation of the systemic inflammatory response and rhabdomyolysis (high concentration of myoglobin) were strongly involved in AKI development. Blood NGAL levels after injury were significantly higher in patients, who developed posttraumatic AKI. Plasma NGAL, lactate, procalcitonin, interleukin-6, and myoglobin had potential to be useful parameters for risk stratification and prediction of AKI after trauma (Tab. 6, Ref. 40).