Introduction of a novel trauma score

Hoffmann, Michael; Lehmann, Wolfgang; Rueger, Johannes M.; Lefering, Rolf

doi:10.1097/ta.0b013e318270d572

Cited by 23 publications

(20 citation statements)

References 23 publications

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“…The first pre-hospital assessment was used; if missing; assessment on admission was used 53.5%* Pupil size Three categories according to the Eppendorf-Cologne Scale [ 12 ]: normal, anisocoria, and bilateral dilated. The first pre-hospital assessment was used; if missing; assessment on admission was used 54.9%* Motor function The motor function was derived from the Glasgow Coma Store (GCS) motor score according to the Eppendorf-Cologne scale [ 12 ]: normal (6 points in GCS); directed (4-5); non-directed (2-3), and none (1). The first pre-hospital assessment was used if available; if missing assessment on admission was used in non-intubated cases 2.7% Mechanism Blunt or penetrating mechanism of injury 6.1% Blood pressure Systolic blood pressure (mmHg), first measurement after admission; in case of missing values the first pre-hospital measurement was used 10.7% Coagulation: INR International normalized ratio (INR); first measurement after admission 12.9% Acidosis: base deficit Base deficit, or base excess (mEq/l); first measurement after admission 46.0% Blood: haemoglobin Haemoglobin (g/dl); first measurement after admission 7.6% CPR Cardiopulmonary resuscitation (CPR), performed pre-hospitally in case of cardiac arrest (not in the emergency room) 3.2% *Actually not part of the reduced data collection form used in 47.4% of cases.…”

Section: Resultsmentioning

confidence: 99%

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Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II

et al. 2014

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IntroductionThe TraumaRegister DGU™ (TR-DGU) has used the Revised Injury Severity Classification (RISC) score for outcome adjustment since 2003. In recent years, however, the observed mortality rate has fallen to about 2% below the prognosis, and it was felt that further prognostic factors, like pupil size and reaction, should be included as well. Finally, an increasing number of cases did not receive a RISC prognosis due to the missing values. Therefore, there was a need for an updated model for risk of death prediction in severely injured patients to be developed and validated using the most recent data.MethodsThe TR-DGU has been collecting data from severely injured patients since 1993. All injuries are coded according to the Abbreviated Injury Scale (AIS, version 2008). Severely injured patients from Europe (ISS ≥4) documented between 2010 and 2011 were selected for developing the new score (n = 30,866), and 21,918 patients from 2012 were used for validation. Age and injury codes were required, and transferred patients were excluded. Logistic regression analysis was applied with hospital mortality as the dependent variable. Results were evaluated in terms of discrimination (area under the receiver operating characteristic curve, AUC), precision (observed versus predicted mortality), and calibration (Hosmer-Lemeshow goodness-of-fit statistic).ResultsThe mean age of the development population was 47.3 years; 71.6% were males, and the average ISS was 19.3 points. Hospital mortality rate was 11.5% in this group. The new RISC II model consists of the following predictors: worst and second-worst injury (AIS severity level), head injury, age, sex, pupil reactivity and size, pre-injury health status, blood pressure, acidosis (base deficit), coagulation, haemoglobin, and cardiopulmonary resuscitation. Missing values are included as a separate category for every variable. In the development and the validation dataset, the new RISC II outperformed the original RISC score, for example AUC in the development dataset 0.953 versus 0.939.ConclusionsThe updated RISC II prognostic score has several advantages over the previous RISC model. Discrimination, precision and calibration are improved, and patients with partial missing values could now be included. Results were confirmed in a validation dataset.

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Section: Resultsmentioning

confidence: 99%

“…Both aspects are easy to assess and have been recorded since the foundation of the registry. However, only recent analyses showed that their predictive ability was even better than the GCS [ 12 - 14 ]. They independently added prognostic information to the prediction model.…”

Section: Discussionmentioning

confidence: 99%

Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II

et al. 2014

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“…Considering prognostic models in TBI, level of consciousness and pupil status represent major predictive features as recently demonstrated by the GCS-P as a novel score 10,20 . This has also been modeled as ECS using pupil reactivity, size and modified motor score 11,21 . However, in aSAH, pupil status in particular has rarely been integrated in prognostic models and grading systems even though it represents an easy assessable feature and pupil reactivity has already been associated with long-term outcome in poor-grade aSAH patients 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Since GCS-P and ECS demonstrated good predictive performance in TBI, we evaluated the prognostic utility of these novel trauma scores for aSAH 10,11 . In comparison to GCS, GCS-P allowed further subclassification of GCS grade 3 patients.…”

Section: Discussionmentioning

confidence: 99%

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Mader

Piffko

Dengler

et al. 2020

Sci Rep

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Prognosis of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH) is onlyinsufficiently displayed by current standard prognostic scores. This study aims to evaluate the role of pupil status for mortality prediction and provide improved prognostic models. Anonymized data of 477 aSAH patients admitted to our medical center from November 2010 to August 2018 were retrospectively analyzed. Identification of variables independently predicting in-hospital mortality was performed by multivariable logistic regression analysis. Final regression models included Hunt & Hess scale (H&H), pupil status and age or in a simplified variation only H&H and pupil status, leading to the design of novel H&H-Pupil-Age score (HHPA) and simplified H&H-Pupil score (sHHP), respectively. In an external validation cohort of 402 patients, areas under the receiver operating characteristic curves (AUROC) of HHPA (0.841) and sHHP (0.821) were significantly higher than areas of H&H (0.794; p < 0.001) or World Federation of Neurosurgical Societies (WFNS) scale (0.775; p < 0.01). Accordingly, including information about pupil status improves the predictive performance of prognostic scores for in-hospital mortality in patients with aSAH. HHPA and sHHP allow simple, early and detailed prognosis assessment while predictive performance remained strong in an external validation cohort suggesting adequate generalizability and low interrater variability.

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“…The mortality in patients with severe TBI was higher than among the ones mild TBI in some studies 28,29 . However, we did not find such difference in the present study.…”

Section: Discussionmentioning

confidence: 88%

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

et al. 2018

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Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay.

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Introduction of a novel trauma score

Abstract: Prognostic study, level III.

Cited by 23 publications

References 23 publications

Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II

Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II

Initial pupil status is a strong predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

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