Top

European Journal of Trauma and Emergency Surgery

Published in:

01-02-2019 | Original Article

Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue

Authors: C. Schröter, F. Urbanek, C. Frömke, M. Winkelmann, P. Mommsen, C. Krettek, C. Zeckey

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2019

Abstract

Purpose

Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics.

Methods

In this prospective study, the ISS was determined prehospital by emergency physicians. The validated AIS and ISS were analyzed based on final diagnoses. A Bland–Altman plot was used in analyzing the agreement between two different assays as well as sensitivity and specificity were determined. Confidence intervals were calculated for a Wilson score. Significance level was set at p ≤ 0.05.

Results

The prehospital ISS was estimated at 26.0 ± 13.0 and was 34.7 ± 16.3 (p < 0.001) after in-hospital validation. In addition, most of the AIS subgroups were significantly higher in the final calculation than preclinically estimated (p < 0.05). When analyzing subgroups of trauma patients (ISS < 16 vs. ISS ≥ 16), we were able to demonstrate a sensitivity of > 90% to identify a multiple-trauma patient. Diagnosing a higher injury severity group (ISS ≥ 25), sensitivity dropped to 61.1%. The Bland–Altman plot demonstrates that injury severity is underestimated in higher injury levels.

Conclusion

Multiple-trauma patients can be identified using the ISS. Anatomic scores might be used for transport decisions; however, an accurate estimation of the injury severity should also be based on other criteria such as patient status, mechanism of injury, and other triage criteria.

van Rein EAJ, Houwert RM, Gunning AC, Lichtveld RA, Leenen LPH, van Heijl M. Accuracy of prehospital triage protocols in selecting severely injured patients: a systematic review. J Trauma Acute Care Surg. 2017;83(2):328–39. https://doi.org/10.1097/TA.0000000000001516.CrossRefPubMed

van Laarhoven JJ, Lansink KW, van Heijl M, Lichtveld RA, Leenen LP. Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma. Injury. 2014;45(5):869–73. https://doi.org/10.1016/j.injury.2013.12.010.CrossRefPubMed

Brown J, Sajankila N, Claridge JA. Prehospital Assessment of Trauma. Surg Clin N Am. 2017;97(5):961–83. https://doi.org/10.1016/j.suc.2017.06.007.CrossRefPubMed

Knudson P, Frecceri CA, DeLateur SA. Improving the field triage of major trauma victims. J Trauma. 1988;28(5):602–6.CrossRefPubMed

Carron PN, Taffe P, Ribordy V, Schoettker P, Fishman D, Yersin B. Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland. Eur J Emerg Med. 2011;18(2):86–93. https://doi.org/10.1097/MEJ.0b013e32833e79fe.CrossRefPubMed

Lehmann R, Brounts L, Lesperance K, Eckert M, Casey L, Beekley A, et al. A simplified set of trauma triage criteria to safely reduce overtriage: a prospective study. Arch Surg. 2009;144(9):853–8. https://doi.org/10.1001/archsurg.2009.153.CrossRefPubMed

Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed

Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;43(6):922–5 (discussion 5–6)CrossRefPubMed

Balogh Z, Offner PJ, Moore EE, Biffl WL. NISS predicts postinjury multiple organ failure better than the ISS. J Trauma. 2000;48(4):624–7 (discussion 7-8)CrossRefPubMed

10.

Sears JM, Blanar L, Bowman SM. Predicting work-related disability and medical cost outcomes: a comparison of injury severity scoring methods. Injury. 2014;45(1):16–22. https://doi.org/10.1016/j.injury.2012.12.024.CrossRefPubMed

11.

Kim SC, Lee KH, Choi HY, Noble J, Lee K, Jeon HJ. On-scene factors that predict severe injury of patients involved in frontal crashes of passenger cars. Eur J Trauma Emerg Surg. 2016. https://doi.org/10.1007/s00068-016-0714-1.CrossRefPubMed

12.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.CrossRefPubMed

13.

Team RC. A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2015. http://www.R-project.org/.

14.

Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.PubMed

15.

Voskens FJ, van Rein EAJ, van der Sluijs R, Houwert RM, Lichtveld RA, Verleisdonk EJ, et al. Accuracy of prehospital triage in selecting severely injured trauma patients. JAMA Surg. 2017. https://doi.org/10.1001/jamasurg.2017.4472.CrossRefPubMedCentral

16.

Harwood PJ, Giannoudis PV, Probst C, Van Griensven M, Krettek C, Pape HC, et al. Which AIS based scoring system is the best predictor of outcome in orthopaedic blunt trauma patients? J Trauma. 2006;60(2):334–40. https://doi.org/10.1097/01.ta.0000197148.86271.13.CrossRefPubMed

17.

Liener UC, Rapp U, Lampl L, Helm M, Richter G, Gaus M, et al. Incidence of severe injuries. Results of a population-based analysis. Unfallchirurg. 2004;107(6):483–90. https://doi.org/10.1007/s00113-004-0771-5.CrossRefPubMed

18.

Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: which scoring system? Injury. 2004;35(4):347–58. https://doi.org/10.1016/S0020-1383(03)00140-2.CrossRefPubMed

19.

Frink M, Zeckey C, Haasper C, Krettek C, Hildebrand F. [Injury severity and pattern at the scene. What is the influence of the mechanism of injury?] Unfallchirurg. 2010;113(5):360–5. https://doi.org/10.1007/s00113-010-1776-x.CrossRefPubMed

20.

Pape HC, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited: An international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg. 2014;77(5):780–6. https://doi.org/10.1097/TA.0000000000000453.CrossRefPubMed

Title: Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue
Authors: C. Schröter
F. Urbanek
C. Frömke
M. Winkelmann
P. Mommsen
C. Krettek
C. Zeckey
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2019
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-017-0888-1

At a glance: The STEP trials

Springer Medicine

Injury severity in polytrauma patients is underestimated using the injury severity score: a single-center correlation study in air rescue

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Erratum to: Simple scoring system for prediction of mortality in Fournier’s gangrene

Civilian cerebral gunshot wounds in rural South African patients are associated with significantly higher mortality rates than in urban patients

Focus on non-union of fractures

Prognostic potential of markers of bone turnover in delayed-healing tibial diaphyseal fractures

Streamlining pre- and intra-hospital care for patients with severe trauma: a white paper from the European Critical Care Foundation

Prevalence of cocaine and derivatives in blood and urine samples of trauma patients and correlation with injury severity: a prospective observational study