Comparison of emergency department trauma triage performance of clinicians and clinical prediction models: a cohort study in India.
BMJ Open
; 10(2): e032900, 2020 02 18.
Article
en En
| MEDLINE
| ID: mdl-32075827
ABSTRACT
OBJECTIVE:
The aim of this study was to evaluate and compare the abilities of clinicians and clinical prediction models to accurately triage emergency department (ED) trauma patients. We compared the decisions made by clinicians with the Revised Trauma Score (RTS), the Glasgow Coma Scale, Age and Systolic Blood Pressure (GAP) score, the Kampala Trauma Score (KTS) and the Gerdin et al model.DESIGN:
Prospective cohort study.SETTING:
Three hospitals in urban India.PARTICIPANTS:
In total, 7697 adult patients who presented to participating hospitals with a history of trauma were approached for enrolment. The final study sample included 5155 patients. The majority (4023, 78.0%) were male. MAIN OUTCOMEMEASURE:
The patient outcome was mortality within 30 days of arrival at the participating hospital. A grid search was used to identify model cut-off values. Clinicians and categorised models were evaluated and compared using the area under the receiver operating characteristics curve (AUROCC) and net reclassification improvement in non-survivors (NRI+) and survivors (NRI-) separately.RESULTS:
The differences in AUROCC between each categorised model and the clinicians were 0.016 (95% CI -0.014 to 0.045) for RTS, 0.019 (95% CI -0.007 to 0.058) for GAP, 0.054 (95% CI 0.033 to 0.077) for KTS and -0.007 (95% CI -0.035 to 0.03) for Gerdin et al. The NRI+ for each model were -0.235 (-0.37 to -0.116), 0.17 (-0.042 to 0.405), 0.55 (0.47 to 0.65) and 0.22 (0.11 to 0.717), respectively. The NRI- were 0.385 (0.348 to 0.4), -0.059 (-0.476 to -0.005), -0.162 (-0.18 to -0.146) and 0.039 (-0.229 to 0.06), respectively.CONCLUSION:
The findings of this study suggest that there are no substantial differences in discrimination and net reclassification improvement between clinicians and all four clinical prediction models when using 30-day mortality as the outcome of ED trauma triage in adult patients. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02838459).Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Médicos
/
Heridas y Lesiones
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Triaje
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Mortalidad Hospitalaria
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Servicio de Urgencia en Hospital
/
Toma de Decisiones Clínicas
/
Modelos Biológicos
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
/
Middle aged
País como asunto:
Asia
Idioma:
En
Año:
2020
Tipo del documento:
Article