Top

Critical Care

Published in:

Open Access 01-12-2019 | Triage | Research

Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score

Authors: Atsushi Shiraishi, Yasuhiro Otomo, Shunsuke Yoshikawa, Koji Morishita, Ian Roberts, Hiroki Matsui

Published in: Critical Care | Issue 1/2019

Abstract

Background

Multiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score.

Methods

The study was a retrospective prognostic study. Data from patients registered in the Japan Trauma Databank (JTDB) were dichotomized into derivation and validation cohorts. Patients’ data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial were assigned to another validation cohort. We obtained age and physiological variables at baseline, created ordinal variables from continuous variables, and defined integer weighting coefficients. Score performance to predict all-cause in-hospital death was assessed using the area under the curve in receiver operating characteristics (AUROC) analyses.

Results

Based on the JTDB derivation cohort (n = 99,867 with 12.5% mortality), the novel score ranged from 0 to 14 points, including 0–2 points for age, 0–6 points for the Glasgow Coma Scale, 0–4 points for systolic blood pressure, and 0–2 points for respiratory rate. The AUROC of the novel score was 0.932 for the JTDB validation cohort (n = 76,762 with 10.1% mortality) and 0.814 for the CRASH-2 cohort (n = 19,740 with 14.6% mortality), which was superior to RTS (0.907 and 0.808, respectively) and MGAP score (0.918 and 0.774, respectively) results.

Conclusions

We report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.

Available only for authorised users

Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA. 1997;277:488–94. https://doi.org/10.1001/jama.1997.03540300056034.CrossRefPubMed

Champion H, Moore L, Vickers RR. Injury severity scoring and outcomes research. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma, 8. New York: McGraw-Hill; 2017. pp. 71–95.

Vincent JL, Opal SM, Marshall JC. Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions. Crit Care Med. 2010;38:283–7. https://doi.org/10.1097/CCM.0b013e3181b785a2.CrossRefPubMed

Jenkins JL, McCarthy ML, Sauer LM, Green GB, Stuart S, Thomas TL, et al. Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23:3–8. https://doi.org/10.1017/S1049023X00005471.CrossRefPubMed

Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med. 1981;9:672–6.CrossRef

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29:623–9.CrossRef

Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoipe M, et al. Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38:831–7. https://doi.org/10.1097/CCM.0b013e3181cc4a67.CrossRefPubMed

Kuhls DA, Malone DL, McCarter RJ, Napolitano LM. Predictors of mortality in adult trauma patients: the Physiologic Trauma Score is equivalent to the Trauma and Injury Severity Score. J Am Coll Surg. 2002;194:695–704. https://doi.org/10.1016/S1072-7515(02)01211-5.CrossRefPubMed

Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011;15:R191. https://doi.org/10.1186/cc10348.CrossRefPubMedPubMedCentral

10.

Gabbe BJ, Cameron PA, Finch CF. Is the Revised Trauma Score still useful? ANZ J Surg. 2003;73:944–8. https://doi.org/10.1046/j.1445-1433.2003.02833.x.CrossRefPubMed

11.

Moore L, Lavoie A, LeSage N, Abdous B, Bergeron E, Liberman M, et al. Statistical validation of the Revised Trauma Score. J Trauma. 2006;60:305–11. https://doi.org/10.1097/01.ta.0000200840.89685.b0.CrossRefPubMed

12.

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. MMWR Recomm Rev. 2009;58:1–35.

13.

Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. 2015;350:g7594. https://doi.org/10.1136/bmj.g7594.CrossRefPubMed

14.

Japan Trauma Care and Research. Japan Trauma Data Bank Report 2016 (2010–2015). https://www.jtcr-jatec.org/traumabank/dataroom/data/JTDB2016e.pdf. Accessed 16 Oct 2017.

15.

CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32. https://doi.org/10.1016/S0140-6736(10)60835-5.CrossRef

16.

CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377:1096–101. https://doi.org/10.1016/S0140-6736(11)60278-X.CrossRef

17.

Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. International comparison of regional trauma registries. Injury. 2012;43:1924–30. https://doi.org/10.1016/j.injury.2012.08.024.CrossRefPubMed

18.

Venables WN, Ripley BD. Modern applied statistics with S. 4th ed. New York: Springer; 2002.CrossRef

19.

Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 2004.

20.

Wood SN. Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models. J Royal Stat Soc B. 2011;73:3–36. https://doi.org/10.1111/j.1467-9868.2010.00749.x.CrossRef

21.

Obuchowski NA, McClish DK. Sample size determination for diagnostic accuracy studies involving binormal ROC curve indices. Stat Med. 1997;16:1529–42. https://doi.org/10.1002/(SICI)1097-0258(19970715)16:13<1529::AID-SIM565>3.0.CO;2-H.CrossRefPubMed

22.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370–8.CrossRef

23.

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the Trauma Register DGU™: the Revised Injury Severity Classification, version II. Crit Care. 2014;18:476. https://doi.org/10.1186/s13054-014-0476-2.CrossRefPubMedPubMedCentral

Title: Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score
Authors: Atsushi Shiraishi
Yasuhiro Otomo
Shunsuke Yoshikawa
Koji Morishita
Ian Roberts
Hiroki Matsui
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Triage
Coma
Published in: Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-019-2636-x

At a glance: The STEP trials

Springer Medicine

Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2019

Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management

The adrenal-vitamin C axis: from fish to guinea pigs and primates

Pre-hospital plasma transfusion: a valuable coagulation support or an expensive fluid therapy?

Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

Enhancer polymorphism rs10865710 associated with traumatic sepsis is a regulator of PPARG gene expression

Sevoflurane and nephrogenic diabetes insipidus on the rise: copeptin to the rescue?