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European Journal of Trauma and Emergency Surgery

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01-12-2021 | Triage | Original Article

Comparative analysis of MGAP, GAP, and RISC2 as predictors of patient outcome and emergency interventional need in emergency room treatment of the injured

Authors: Michael Zeindler, Felix Amsler, Thomas Gross

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2021

Abstract

Purpose

Little is known about the capabilities of triage and risk scores to predict the outcomes of injured patients, other than mortality, or to determine the need for trauma center resources.

Methods

Retrospective analysis of prospectively gathered monocenter data on consecutively admitted adult emergency room trauma patients. For each patient, the GAP (Glasgow Coma Scale, Age and Pressure), MGAP (mechanism + GAP) scores and the revised injury severity classification 2 (RISC2) were calculated. The predictive performance of these scores was compared for the assessment of trauma severity, hospital resource need and early patient outcomes (area under the receiver operator characteristics, AUROC).

Results

2112 patients were evaluated [mean age 49.1 years; Injury Severity Score (ISS) 9.5]. GAP, MGAP, and RISC2 worked best at predicting mortality (AUROC 93.2, 93.5 and 96.1%, respectively). Other endpoints such as ISS > 15, emergency interventions, disability status, and return-not-home were predicted less precisely by these three scores, better by RISC2 (AUROC range 66.2–88.8%) than by (M)GAP-scores (55.2–84.1%), except for preclinical interventions. Over- and undertriage rates for the (M)GAP scores varied between 27.5–53.4% and 10.4–30%, respectively.

Conclusion

The almost comparable precision of the three risk scores in the prediction of outcome or interventional need following trauma, and the fact, that the RISC2 can only be calculated following extensive diagnostics, favor earlier applicable (M)GAP scoring in the emergency setting. Overall, due to its easier use, the GAP appears to be the most preferable for the early assessment and triage of the injured in a trauma setting based on this European trauma center experience (NCT 02165137).

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Frydrych LM, Keeney-Bonthrone TP, Gwinn E, Wakam GK, Anderson MS, Delano MJ. Short-term versus long-term trauma mortality: a systematic review. J Trauma Acute Care Surg. 2019;87(4):990–7. https://doi.org/10.1097/ta.0000000000002430.CrossRefPubMed

Swiss Federal Bureau of, Statistics (2016) Specific cause of death statistics for the year 2015. In: Federal Bureau of Statistics 2015.

Atzema C, Mower WR, Hoffman JR, Holmes JF, Killian AJ, Oman JA, et al. Defining "therapeutically inconsequential" head computed tomographic findings in patients with blunt head trauma. Ann Emerg Med. 2004;44(1):47–56.CrossRef

Rotondo MF, Cribari C, Smith RS. Resources for optimal care of the injured patient 2014. Chicago: American College of Surgeons Committee on Trauma; 2014.

Rehn M, Perel P, Blackhall K, Lossius HM. Prognostic models for the early care of trauma patients: a systematic review. Scand J Trauma Resusc Emerg Med. 2011;19:17.CrossRef

MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78.CrossRef

Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010;69(3):595–9. https://doi.org/10.1097/TA.0b013e3181ee6e32(discussion 9-601).CrossRefPubMed

Braken P, Amsler F, Gross T. Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage—a cross sectional study. Scand J Trauma Resusc Emerg Med. 2018;26(1):32. https://doi.org/10.1186/s13049-018-0498-x.CrossRefPubMedPubMedCentral

Newgard CD, Richardson D, Holmes JF, Rea TD, Hsia RY, Mann NC, et al. Physiologic field triage criteria for identifying seriously injured older adults. Prehosp Emerg Care. 2014;18(4):461–70. https://doi.org/10.3109/10903127.2014.912707.CrossRefPubMedPubMedCentral

10.

Allen CJ, Baldor DJ, Schulman CI, Pizano LR, Livingstone AS, Namias N. Assessing field triage decisions and the International Classification Injury Severity Score (ICISS) at predicting outcomes of trauma patients. Am Surg. 2017;83(6):648–52.CrossRef

11.

Sartorius D, Manach YL, David JS, Rancurel E, Smail N, Thicoipé M, et al. Mechanism, Glasgow Coma Scale, age, and arterial pressure (MGAP): a new prehospital triage to predict mortality in trauma patients. Crit Care Med. 2010;38:831–7.CrossRef

12.

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.CrossRef

13.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli T, Flanagan ME. A revision of the trauma score. J Trauma Inj Infect Crit Care. 1989;29(5):623–9.CrossRef

14.

Moore L, Lavoie A, Abdous B, Le Sage N, Liberman M, Bergeron E, et al. Unification of the revised trauma score. J Trauma-Inj Infect Crit Care. 2006;61:718–22.CrossRef

15.

Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH, et al. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017;17(1):77. https://doi.org/10.1186/s12893-017-0272-4.CrossRefPubMedPubMedCentral

16.

Jones JM, Skaga NO, Sovik S, Lossius HM, Eken T. Norwegian survival prediction model in trauma: modelling effects of anatomic injury, acute physiology, age, and co-morbidity. Acta Anaesthesiol Scand. 2014;58(3):303–15. https://doi.org/10.1111/aas.12256.CrossRefPubMedPubMedCentral

17.

Miller RT, Nazir N, McDonald T, Cannon CM. The modified rapid emergency medicine score: a novel trauma triage tool to predict in-hospital mortality. Injury. 2017;48:1870–7 (early pub ahead).CrossRef

18.

Raux M, Sartorius D, Le Manach Y, David JS, Riou B, Vivien B. What do prehospital trauma scores predict besides mortality? J Trauma. 2011;71(3):754–9. https://doi.org/10.1097/TA.0b013e3181fd0dae.CrossRefPubMed

19.

David JS, Voiglio EJ, Cesareo E, Vassal O, Decullier E, Gueugniaud PY, et al. Prehospital parameters can help to predict coagulopathy and massive transfusion in trauma patients. Vox Sang. 2017;112(6):557–66. https://doi.org/10.1111/vox.12545.CrossRefPubMed

20.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. J Trauma-Inj Infect Crit Care. 1987;27(4):370–8.CrossRef

21.

Lefering R. Development and validation of the Revised Injury Severity Classification Score for severely injured patients. Eur J Trauma Emerg Surg. 2009;5(35):437–47.CrossRef

22.

Stoica B, Paun S, Tanase I, Negoi I, Chiotoroiu A, Beuran M. Probability of survival scores in different trauma registries: a systematic review. Chirurgia (Bucur). 2016;111(2):115–9.

23.

Brilej D, Vlaovic M, Komadina R. Improved prediction from revised injury severity classification (RISC) over trauma and injury severity score (TRISS) in an independent evaluation of major trauma patients. J Int Med Res. 2010;38(4):1530–8. https://doi.org/10.1177/147323001003800437.CrossRefPubMed

24.

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the traumaregister DGU: the revised injury severity classification, version II. Crit Care. 2014;18:476.CrossRef

25.

Bouzat P, Legrand R, Gillois P, Ageron FX, Brun J, Savary D, et al. Prediction of intra-hospital mortality after severe trauma: which pre-hospital score is the most accurate? Injury. 2016;47(1):14–8.CrossRef

26.

Hung YW, He H, Mehmood A, Botchey I, Saidi H, Hyder AA, et al. Exploring injury severity measures and in-hospital mortality: a multi-hospital study in Kenya. Injury. 2017;48(10):2112–8. https://doi.org/10.1016/j.injury.2017.07.001.CrossRefPubMed

27.

Laytin AD, Dicker RA, Gerdin M, Roy N, Sarang B, Kumar V, et al. Comparing traditional and novel injury scoring systems in a US level-I trauma center: an opportunity for improved injury surveillance in low- and middle-income countries. J Surg Res. 2017;215:60–6. https://doi.org/10.1016/j.jss.2017.03.032.CrossRefPubMed

28.

Bundi M, Meier L, Amsler F, Gross T. Impact of weather, time of day and season on the admission and outcome of major trauma patients. Der Unfallchirurg. 2016;121(1):10–9.CrossRef

29.

Gross T, Braken P, Amsler F. Trauma center need: the American College of Surgeons’ definition in contrast to Swiss highly specialized medicine regulations—a Swiss trauma center perspective. Eur J Trauma Emerg Surg. 2018. https://doi.org/10.1007/s00068-018-1027-3.CrossRefPubMed

30.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRef

31.

Hasler RMMDM, Mealing NP, Rothen HUMD, Coslovsky MP, Lecky FMDP, Juni PMD. Validation and reclassification of MGAP and GAP in hospital settings using data from the Trauma Audit and Research Network. J Trauma Acute Care Surg. 2014;77(5):757–63.CrossRef

32.

Gennarelli T. The Abbreviated Injury Scale—1990 revision. Des Plaines: American Association for the Advancement of Automotive Medicine (AAAM); 1990.

33.

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.CrossRef

34.

Osler T, Baker SP, Long W. A modification of the Injury Severity Score that both improves accuracy and simplifies scoring. J Trauma-Inj Infect Crit Care. 1997;43(6):922–6.CrossRef

35.

Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;7905:480–4.CrossRef

36.

Ross SE, Leipold C, Terregino C, O'Malley KF. Efficacy of the motor component of the Glasgow Coma Scale in trauma triage. J Trauma. 1998;45(1):42–4.CrossRef

37.

Meredith W, Rutledge R, Hansen AR, Oller DW, Thomason M, Cunningham P, et al. Field triage of trauma patients based upon the ability to follow commands: a study in 29,573 injured patients. J Trauma. 1995;38(1):129–35.CrossRef

38.

Beck B, Smith K, Mercier E, Bernard S, Jones C, Meadley B, et al. Potentially preventable trauma deaths: a retrospective review. Injury. 2019;50(5):1009–166. https://doi.org/10.1016/j.injury.2019.03.003.CrossRefPubMed

39.

Austin SR, Wong Y-N, Uzzo RG, Beck JR, Egleston BL. Why summary comorbidity measures such as the Charlson comorbidity index and Elixhauser score work. Med Care. 2015;53(9):e65–e72. https://doi.org/10.1097/MLR.0b013e318297429c.CrossRefPubMedPubMedCentral

40.

Laytin AD, Kumar V, Juillard CJ, Sarang B, Lashoher A, Roy N, et al. Choice of injury scoring system in low- and middle-income countries: lessons from Mumbai. Injury. 2015;46(12):2491–7. https://doi.org/10.1016/j.injury.2015.06.029.CrossRefPubMed

41.

Edmonds ZV, Mower WR, Lovato LM, Lomeli R. The reliability of vital sign measurements. Ann Emerg Med. 2002;39(3):233–7.CrossRef

42.

Gill MR, Reiley DG, Green SM. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. 2004;43(2):215–23. https://doi.org/10.1016/s019606440300814x.CrossRefPubMed

43.

Chou R, Totten AM, Pappas M, Carney N, Dandy S, Grusing S et al. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review. AHRQ Comparative Effectiveness Reviews. 2017; Report No.: 16(17)-EHC041-EF.

44.

Heim C, Bosisio F, Roth A, Bloch J, Borens O, Daniel RT, et al. Is trauma in Switzerland any different? Epidemiology and patterns of injury in major trauma—a 5-year review from a Swiss trauma centre. Swiss Med Wkly. 2014;144:w13958.PubMed

45.

Zacher MT, Kanz KG, Hanschen M, Häberle S, van Griensven M, Lefering R, et al. Association between volume of severely injured patients and mortality in German trauma hospitals. Br J Surg. 2015;102(10):1213–9.CrossRef

46.

Fu C-Y, Bajani F, Tatebe L, Butler C, Starr F, Dennis A, et al. Right hospital, right patients: penetrating injury patients treated at high-volume penetrating trauma centers have lower mortality. J Trauma Acute Care Surg. 2019;86(6):961–6. https://doi.org/10.1097/ta.0000000000002245.CrossRefPubMed

47.

Schellenberg M, Benjamin E, Bardes JM, Inaba K, Demetriades D. Undertriaged trauma patients: Who are we missing? J Trauma Acute Care Surg. 2019;87(4):865–9. https://doi.org/10.1097/ta.0000000000002393.CrossRefPubMed

Title: Comparative analysis of MGAP, GAP, and RISC2 as predictors of patient outcome and emergency interventional need in emergency room treatment of the injured
Authors: Michael Zeindler
Felix Amsler
Thomas Gross
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keyword: Triage
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01361-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparative analysis of MGAP, GAP, and RISC2 as predictors of patient outcome and emergency interventional need in emergency room treatment of the injured

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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