Independent Predictors of Early Death of Polytrauma Patients: An Analysis of 696 Patients

Mica, Ladislav; Albrecht, Katja; Keel, Marius; Trentz, O.

doi:10.4172/2167-1222.1000118

Cited by 11 publications

(17 citation statements)

References 32 publications

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“…Similar admission lactate levels and statistically significant difference in admission lactate levels between compared groups from the present study were also found in other studies [ 3 , 9 , 15 ]. Lactate was found as a modest predictor of outcome with AUC from 0.69 to 0.73 [ 6 , 9 , 12 , 15 ]. Our data showed better accuracy of lactate as a predictor of mortality with AUC of 0.82.…”

Section: Discussionsupporting

confidence: 92%

Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

Strnad

Lesjak²,

Vujanović³

et al. 2015

BioMed Research International

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This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n = 40) and nonsurvivors (n = 30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P = 0.006), with lower initial GCS (P < 0.001) and higher ISS (P < 0.001), along with higher lactate (P < 0.001) and larger base deficit (BD; P = 0.006), whereas RTS (P = 0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P < 0.001), for ISS 0.82 (P < 0.001), and for BD 0.69 (P = 0.006). Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P = 0.037), GCS (P = 0.033), and age (P = 0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P < 0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

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Section: Discussionsupporting

confidence: 92%

Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

Strnad

Lesjak²,

Vujanović³

et al. 2015

BioMed Research International

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“…SIRS was defined as the presence of two or more of the following criteria: body temperature > 38 °C or < 36 °C, heart rate > 90 bpm, respiratory rate > 20 breaths/min or PaCO 2 < 32 mmHg, and white blood cell count >12,000/µL or <4000/µL. The same criteria apply for the presentation of sepsis, with an additional infectious focus [ 7 , 8 , 9 ]. TRISS includes six physiological and clinical parameters.…”

Section: Methodsmentioning

confidence: 99%

Validation of a Visual-Based Analytics Tool for Outcome Prediction in Polytrauma Patients (WATSON Trauma Pathway Explorer) and Comparison with the Predictive Values of TRISS

Niggli

Pape

Niggli

et al. 2021

JCM

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Introduction: Big data-based artificial intelligence (AI) has become increasingly important in medicine and may be helpful in the future to predict diseases and outcomes. For severely injured patients, a new analytics tool has recently been developed (WATSON Trauma Pathway Explorer) to assess individual risk profiles early after trauma. We performed a validation of this tool and a comparison with the Trauma and Injury Severity Score (TRISS), an established trauma survival estimation score. Methods: Prospective data collection, level I trauma centre, 1 January 2018–31 December 2019. Inclusion criteria: Primary admission for trauma, injury severity score (ISS) ≥ 16, age ≥ 16. Parameters: Age, ISS, temperature, presence of head injury by the Glasgow Coma Scale (GCS). Outcomes: SIRS and sepsis within 21 days and early death within 72 h after hospitalisation. Statistics: Area under the receiver operating characteristic (ROC) curve for predictive quality, calibration plots for graphical goodness of fit, Brier score for overall performance of WATSON and TRISS. Results: Between 2018 and 2019, 107 patients were included (33 female, 74 male; mean age 48.3 ± 19.7; mean temperature 35.9 ± 1.3; median ISS 30, IQR 23–36). The area under the curve (AUC) is 0.77 (95% CI 0.68–0.85) for SIRS and 0.71 (95% CI 0.58–0.83) for sepsis. WATSON and TRISS showed similar AUCs to predict early death (AUC 0.90, 95% CI 0.79–0.99 vs. AUC 0.88, 95% CI 0.77–0.97; p = 0.75). The goodness of fit of WATSON (X2 = 8.19, Hosmer–Lemeshow p = 0.42) was superior to that of TRISS (X2 = 31.93, Hosmer–Lemeshow p < 0.05), as was the overall performance based on Brier score (0.06 vs. 0.11 points). Discussion: The validation supports previous reports in terms of feasibility of the WATSON Trauma Pathway Explorer and emphasises its relevance to predict SIRS, sepsis, and early death when compared with the TRISS method.

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“…Reported predictors from literatures were mainly from developed countries with an established trauma database. 7 Among the reported predictors of death was pH of more than 7.2, body temperature of less than 34°C, blood replacement of more than 4000 mL, total fluid replacement of more than 10 000 mL and blood loss of more than 15 mL/min. Reported predictors for survival from traumatic injuries were presence of a penetrating trauma, spontaneous breathing, avoidance of emergency thoracotomy, Injury Severity Score (ISS) ≤20, packed red blood cell replacement of more than 4000 mL and absence of abdominal vascular injury.…”

Section: Introductionmentioning

confidence: 99%

Prognostic predictors of early mortality from exsanguination in adult trauma: a Malaysian trauma center experience

Huei

Mohamad

Lip

et al. 2017

Trauma Surg Acute Care Open

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BackgroundTrauma mortality due to exsanguination is the second most common cause of death. The objective of this study is to investigate the predictors for early death from exsanguination.MethodsA prognostic study was done to identify predictors of early mortality due to exsanguination. Data were extracted from our Trauma Surgery Registry database of Sultanah Aminah Hospital, Johor Bahru, Malaysia. All patients who were treated from May 1, 2011 to April 31, 2014 by the trauma team were included. Adult trauma patients included from the Trauma Surgery Registry were divided into two groups for analysis: early death from exsanguination and death from non-exsanguination/survivors. Univariate and multivariate analysis was performed to look for significant predictors of death from exsanguination. Variables analyzed were demography, mechanism of injury, organ injury scale, physiological parameters (systolic blood pressure (SBP), respiratory rate, heart rate, temperature), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS) and cause of death.ResultsA total of 2208 patients with an average age of 36 (±16) years were included. Blunt trauma was the majority with 90.5%, followed by penetrating injuries (9.2%). The overall mortality is 239 out of 2208 (10.8%). Seventy-eight patients (32.6%) died due to central nervous system injury, 69 due to sepsis (28.9%) and 58 due to exsanguination (24.3%). After multivariate analysis, age (OR 1.026 (1.009 to 1.044), p=0.002), SBP (OR 0.985 (0.975 to 0.995), p=0.003) and temperature (OR 0.203 (0.076 to 0.543), p=0.001) were found to be the significant physiological parameters. Intra-abdominal injury and NISS were significant anatomic mortality predictors from exsanguination (p<0.001). Patients with intra-abdominal injury had four times higher risk of mortality from exsanguination (OR 3.948 (2.331 to 6.686), p<0.001).DiscussionIn a Malaysian trauma center, age, SBP, core body temperature, intra-abdominal injury and NISS were significant predictors of early death from exsanguination.Level of evidenceII.

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Independent Predictors of Early Death of Polytrauma Patients: An Analysis of 696 Patients

Cited by 11 publications

References 32 publications

Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

Validation of a Visual-Based Analytics Tool for Outcome Prediction in Polytrauma Patients (WATSON Trauma Pathway Explorer) and Comparison with the Predictive Values of TRISS

Prognostic predictors of early mortality from exsanguination in adult trauma: a Malaysian trauma center experience

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