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Abstract
Background Identification of trauma patients at significant risk of death in the prehospital setting is challenging. The prediction probability of basic indices like vital signs, Shock Index (SI), SI multiplied by age (SIA) or the GCS is limited and more complex scores are not feasible on-scene. The Reverse SI multiplied by GCS score (rSIG) has been proposed as a triage tool to identify trauma patients with an increased risk of dying at EDs. Age adjustment (rSIG/A) displayed no advantage.
We aim to (1) validate the accuracy of the rSIG in predicting death or early transfusion in a large trauma registry population, and (2) determine if the rSIG is valid for evaluation of trauma patients in the prehospital setting.
Methods 70 829 trauma patients were retrieved from the TraumaRegister DGU database (time period between 2008 and 2017). The area under the receiver operating characteristic curve (AUROC) was calculated to measure the ability of SI, SIA, rSIG and rSIG divided by age (rSIG/A) to predict in-hospital mortality from data at the time of hospital arrival and solely from prehospital data.
Results The rSIG at time of hospital admission was not sufficiently predictive for clinical decision-making. However, rSIG calculated solely from prehospital data accurately predicted risk of death. Using prehospital data, the AUROC for mortality of rSIG/A was the highest (0.85; CI: 0.85 to 0.86), followed by rSIG (0.76; CI: 0.75 to 0.77), SIA (0.71; CI: 0.70 to 0.71) and SI (0.48; CI: 0.47 to 0.49).
Conclusion The prehospital rSIG/A can be a useful adjunct for the prehospital evaluation of trauma patients and their allocation to trauma centres or trauma team activation. However, we could not confirm that the rSIG at hospital admission is a reliable tool for risk stratification.
- emergency ambulance systems
- emergency care systems
- major trauma management
- risk management
- pre-hospital
Data availability statement
All data relevant to the study are included in the article. For the study, the data from the TraumaRegister DGU (TR-DGU) were used. The present study is in line with the publication guidelines of the TR-DGU and registered as TR-DGU project ID 2018-017.
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Data availability statement
All data relevant to the study are included in the article. For the study, the data from the TraumaRegister DGU (TR-DGU) were used. The present study is in line with the publication guidelines of the TR-DGU and registered as TR-DGU project ID 2018-017.
Footnotes
Handling editor Jason E Smith
Collaborators TraumaRegister DGU**Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Berlin, Germany.
Contributors SF was responsible for the study protocol, extracting and analysing data, interpretation of the results, writing the manuscript and is is responsible for the overall content as guarantor. RL retrieved the data from the TraumaRegister DGU database, provided professional advice on study design and analysed the data. JG and ND contributed to the conception of the manuscript, ethical approval and proofreading the draft. TAS and CW supervised the conduct of the study and data collection and revised the draft. UH supervised the project, helped develop the study design, reviewed all charts and data, as well as revised the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.