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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2011 | Review

Prognostic models for the early care of trauma patients: a systematic review

Authors: Marius Rehn, Pablo Perel, Karen Blackhall, Hans Morten Lossius

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2011

Abstract

Background

Early identification of major trauma may contribute to timely emergency care and rapid transport to an appropriate health-care facility. Several prognostic trauma models have been developed to improve early clinical decision-making.

Methods

We systematically reviewed models for the early care of trauma patients that included 2 or more predictors obtained from the evaluation of an adult trauma victim, investigated their quality and described their characteristics.

Results

We screened 4 939 records for eligibility and included 5 studies that derivate 5 prognostic models and 9 studies that validate one or more of these models in external populations. All prognostic models intended to change clinical practice, but none were tested in a randomised clinical trial. The variables and outcomes were valid, but only one model was derived in a low-income population. Systolic blood pressure and level of consciousness were applied as predictors in all models.

Conclusions

The general impression is that the models perform well in predicting survival. However, there are many areas for improvement, including model development, handling of missing data, analysis of continuous measures, impact and practicality analysis.

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The global burden of disease: 2004 update. 2008, Geneva: World Health Organization

Sasser S, Varghese M, Kellermann A, Lormand J: Prehospital trauma care systems. 2005, Geneva: World Health Organization

MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO: A national evaluation of the effect of trauma-center care on mortality. New England Journal of Medicine. 2006, 354: 366-378. 10.1056/NEJMsa052049.CrossRefPubMed

ACS-COT: Resources for optimal care of the injured patient: 2006. 2006, Chicago: American College of Surgeons

Petrie D, Lane P, Stewart TC: An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis. Trauma and Injury Severity Score. Journal of Trauma-Injury Infection & Critical Care. 1996, 41: 870-873. discussion 873-875.CrossRef

Rehn M, Eken T, Kruger AJ, Steen PA, Skaga NO, Lossius HM: Precision of field triage in patients brought to a trauma centre after introducing trauma team activation guidelines. Scand J Trauma Resusc Emerg Med. 2009, 17: 1-10.1186/1757-7241-17-1.PubMedCentralCrossRefPubMed

Hayden JA, Cote P, Steenstra IA, Bombardier C: Identifying phases of investigation helps planning, appraising, and applying the results of explanatory prognosis studies. J Clin Epidemiol. 2008, 61: 552-560. 10.1016/j.jclinepi.2007.08.005.CrossRefPubMed

Rothman K, Greenland S, Lash T: Modern Epidemiology. 2008, Philadelphia: Lippincott Wiliams & Wilkins, 3

Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, Henry MC, Salomone JP, Wang SC, Galli RL: Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. Morbidity & Mortality Weekly Report. 2009, 58: 1-35.Recommendations & Reports.,

10.

Moons KGM, Royston P, Vergouwe Y, Grobbee DE, Altman DG: Prognosis and prognostic research: what, why, and how?. BMJ. 2009, 338: b375-10.1136/bmj.b375.CrossRefPubMed

11.

Royston P, Moons KGM, Altman DG, Vergouwe Y: Prognosis and prognostic research: Developing a prognostic model. BMJ. 2009, 338: b604-10.1136/bmj.b604.CrossRefPubMed

12.

Altman DG, Vergouwe Y, Royston P, Moons KGM: Prognosis and prognostic research: validating a prognostic model. BMJ. 2009, 338: b605-10.1136/bmj.b605.CrossRefPubMed

13.

Moons KGM, Altman DG, Vergouwe Y, Royston P: Prognosis and prognostic research: application and impact of prognostic models in clinical practice. BMJ. 2009, 338: b606-10.1136/bmj.b606.CrossRefPubMed

14.

Reilly BM, Evans AT: Translating clinical research into clinical practice: impact of using prediction rules to make decisions. Annals of Internal Medicine. 2006, 144: 201-209.CrossRefPubMed

15.

Stiell IG, Wells GA: Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med. 1999, 33: 437-447. 10.1016/S0196-0644(99)70309-4.CrossRefPubMed

16.

Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974, 2: 81-84. 10.1016/S0140-6736(74)91639-0.CrossRefPubMed

17.

Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009, 339: b2535-10.1136/bmj.b2535.PubMedCentralCrossRefPubMed

18.

Whiting P, Harbord R, Kleijnen J: No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Medical Research Methodology. 2005, 5: 19-10.1186/1471-2288-5-19.PubMedCentralCrossRefPubMed

19.

Juni P, Altman DG, Egger M: Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ. 2001, 323: 42-46. 10.1136/bmj.323.7303.42.PubMedCentralCrossRefPubMed

20.

Gormican SP: CRAMS scale: field triage of trauma victims. Ann Emerg Med. 1982, 11: 132-135. 10.1016/S0196-0644(82)80237-0.CrossRefPubMed

21.

Koehler JJ, Baer LJ, Malafa SA, Meindertsma MS, Navitskas NR, Huizenga JE: Prehospital Index: a scoring system for field triage of trauma victims. Ann Emerg Med. 1986, 15: 178-182. 10.1016/S0196-0644(86)80016-6.CrossRefPubMed

22.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME: A revision of the Trauma Score. Journal of Trauma-Injury Infection & Critical Care. 1989, 29: 623-629.CrossRef

23.

Husum H, Gilbert M, Wisborg T, Van Heng Y, Murad M: Respiratory rate as a prehospital triage tool in rural trauma. Journal of Trauma-Injury Infection & Critical Care. 2003, 55: 466-470.CrossRef

24.

Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoipe M, Wiel E, Ricard-Hibon A, Berthier F, Gueugniaud PY, Riou B: Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Critical Care Medicine. 2010, 38: 831-837. 10.1097/CCM.0b013e3181cc4a67.CrossRefPubMed

25.

Baxt WG, Berry CC, Epperson MD, Scalzitti V: The failure of prehospital trauma prediction rules to classify trauma patients accurately. Ann Emerg Med. 1989, 18: 1-8. 10.1016/S0196-0644(89)80302-6.CrossRefPubMed

26.

Emerman CL, Shade B, Kubincanek J: Comparative performance of the Baxt Trauma Triage Rule. Am J Emerg Med. 1992, 10: 294-297. 10.1016/0735-6757(92)90005-I.CrossRefPubMed

27.

Ahmad HN: Evaluation of revised trauma score in polytraumatized patients. J Coll Physicians Surg Pak. 2004, 14: 286-289.PubMed

28.

Moore L, Lavoie A, Abdous B, Le Sage N, Liberman M, Bergeron E, Emond M: Unification of the revised trauma score. J Trauma. 2006, 61: 718-722. 10.1097/01.ta.0000197906.28846.87. discussion 722.CrossRefPubMed

29.

Roorda J, van Beeck EF, Stapert JW, ten Wolde W: Evaluating performance of the Revised Trauma score as a triage instrument in the prehospital setting.[see comment]. Injury. 1996, 27: 163-167. 10.1016/0020-1383(95)00218-9.CrossRefPubMed

30.

Al-Salamah MA, McDowell I, Stiell IG, Wells GA, Perry J, Al-Sultan M, Nesbitt L: Initial emergency department trauma scores from the OPALS study: the case for the motor score in blunt trauma. Acad Emerg Med. 2004, 11: 834-842. 10.1111/j.1553-2712.2004.tb00764.x.CrossRefPubMed

31.

Bond RJ, Kortbeek JB, Preshaw RM: Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool. J Trauma. 1997, 43: 283-287. 10.1097/00005373-199708000-00013.CrossRefPubMed

32.

Tamim H, Joseph L, Mulder D, Battista RN, Lavoie A, Sampalis JS: Field triage of trauma patients: improving on the Prehospital Index. Am J Emerg Med. 2002, 20: 170-176. 10.1053/ajem.2002.32646.CrossRefPubMed

33.

Plant JR, MacLeod DB, Korbeek J: Limitations of the prehospital index in identifying patients in need of a major trauma center. Ann Emerg Med. 1995, 26: 133-137. 10.1016/S0196-0644(95)70142-7.CrossRefPubMed

34.

Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ: Trauma score. Crit Care Med. 1981, 9: 672-676. 10.1097/00003246-198109000-00015.CrossRefPubMed

35.

Baker SP, O'Neill B, Haddon W, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. Journal of Trauma-Injury Infection & Critical Care. 1974, 14: 187-196.CrossRef

36.

Norwood SH, McAuley CE, Berne JD, Vallina VL, Creath RG, McLarty J: A prehospital glasgow coma scale score < or = 14 accurately predicts the need for full trauma team activation and patient hospitalization after motor vehicle collisions. J Trauma. 2002, 53: 503-507. 10.1097/00005373-200209000-00018.CrossRefPubMed

37.

Crossman J, Bankes M, Bhan A, Crockard HA: The Glasgow Coma Score: reliable evidence?. Injury. 1998, 29: 435-437. 10.1016/S0020-1383(98)00079-5.CrossRefPubMed

38.

Rowley G, Fielding K: Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet. 1991, 337: 535-538. 10.1016/0140-6736(91)91309-I.CrossRefPubMed

39.

The EAST Practice Management Guidelines Work Group: Practice Management Guidelines for the Appropriate Triage of the Victim of Trauma. 2010, Eastern Association for the Surgery of Trauma

40.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003, 138: W1-12.CrossRefPubMed

41.

Ringdal KG, Coats TJ, Lefering R, Di Bartolomeo S, Steen PA, Roise O, Handolin L, Lossius HM: The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med. 2008, 16: 7-10.1186/1757-7241-16-7.PubMedCentralCrossRefPubMed

Title: Prognostic models for the early care of trauma patients: a systematic review
Authors: Marius Rehn
Pablo Perel
Karen Blackhall
Hans Morten Lossius
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2011
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-19-17

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic models for the early care of trauma patients: a systematic review

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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