Trauma score versus revised trauma score in TRISS to predict outcome in children with blunt trauma

Eichelberger, Martin R.; Bowman, Leon M.; Sacco, William J.; Mangubat, E. Antonio; Lowenstein, Adam; Gotschall, Catherine S.

doi:10.1016/s0196-0644(89)80457-3

Cited by 37 publications

(15 citation statements)

References 14 publications

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“…Out‐of‐hospital prediction rules such as the Revised Trauma Score, 23 the Circulation, Respiration, Abdomen, Motor, Speech (CRAMS) Scale, 24 and the Prehospital Index 25 have been used to classify patients with various disease‐specific syndromes. Most of these rules have used physiologic parameters to predict injury severity for trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Validation of the Philadelphia EMS Admission Rule (PEAR) to Predict Hospital Admission in Adult Patients Using Out‐of‐hospital Data

Meisel¹,

Mathew²,

Wydro³

et al. 2009

Academic Emergency Medicine

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Objectives: The objective was to validate a previously derived prediction rule for hospital admission using routinely collected out-of-hospital information. Methods:The authors performed a multicenter retrospective cohort study of 1,500 randomly selected, adult patients transported to six separate emergency departments (EDs; three community and three academic hospitals in three separate health systems) by a city-run emergency medical services (EMS) system over a 1-year period. Patients younger than 18 years or who bypassed the ED to be evaluated by trauma, obstetric, or psychiatric teams were excluded. The score consisted of six weighted elements that generated a total score (0-14): age ‡ 60 years (3 points); chest pain (3); shortness of breath (3); dizzy, weakness, or syncope (2); history of cancer (2); and history of diabetes (1). Receiver operator characteristic (ROC) curves for the decision rule and admission rates were calculated among individual hospitals and for the entire cohort.Results: A total of 1,102 patients met inclusion criteria. The admission rate for the entire cohort was 40%, and individual hospital admission rates ranged from 28% to 57%. Overall, 34% had a score of ‡4, and 29% had a score of ‡5. Area under the ROC curve (AUC) for the combined cohort was 0.83 for all admissions and 0.72 for intensive care unit (ICU) admissions; AUCs at individual hospitals ranged from 0.72 to 0.85. The admission rate for a score of ‡4 was 77%; for a score of ‡5 the admission rate was 80%. Conclusions:The ability of this EMS rule to predict the likelihood of hospital admission appears valid in this multicenter cohort. Further studies are needed to measure the impact and feasibility of using this rule to guide decision-making.ACADEMIC EMERGENCY MEDICINE 2009; 16:519-525 ª

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Section: Discussionmentioning

confidence: 99%

Multicenter Validation of the Philadelphia EMS Admission Rule (PEAR) to Predict Hospital Admission in Adult Patients Using Out‐of‐hospital Data

Meisel¹,

Mathew²,

Wydro³

et al. 2009

Academic Emergency Medicine

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“…[45] Most studies evaluating pediatric trauma care have compared the outcome of a single ATC or PTC to a large, multicenter reference population using the TRISS methodology. [6] While some investigators have reported improved survival for injured children treated at a PTC compared with the national norms,[7–9] other authors have demonstrated comparable outcomes for children treated at an ATC to national standards. [10–14]…”

Section: Introductionmentioning

confidence: 99%

Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system

Amini¹,

Lavoie

Moore³

et al. 2011

J Emerg Trauma Shock

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Background:Previous studies have shown divergent results regarding the survival of injured children treated at pediatric trauma centers (PTC) and adult trauma centers (ATC).Aims:(1) To document, in a regionalized inclusive trauma system, at which level of trauma centers were the injured children treated and (2) to compare the in-hospital mortality over five levels of trauma care, ranging from pediatric level I trauma centers (PTC) to designated local trauma hospitals (level IV) for the whole study sample and for subgroups of severely injured children and head trauma.Materials and Methods:A retrospective analysis included data on 11,053 injured children (age ≤16 years) treated between April 1998 and March 2005 in 58 designated trauma hospitals in the province of Quebec, Canada. Multiple imputation was used to handle missing physiological data and multivariate logistic regression was used to compare mortality over levels of care.Results:PTC treated 52.2% of the children. Children treated at PTC were more often transferred from another hospital (73%) and were more severely injured. ATC level I, II, III and IV centers treated, respectively, 3.0%, 16.2%, 24.3% and 4.3% of children. Compared with children treated at a PTC, the risk of mortality was higher for children treated at each other ATC, i.e. level I (adjusted odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.3–7.5), level II (OR = 2.5; 95% CI: 1.3–5.0), level III (OR = 5.2; 95% CI: 2.1–13.1) and level IV (OR = 9.9; 95% CI: 2.4–41.3). Similar findings were observed among the subsamples of children who were more severely injured (Injury Severity Score >15) and who sustained head injuries.Conclusions:In our trauma system, PTC cared for more than half of the injured children and patients treated there have better survival than those treated at all other levels of ATC.

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“…Studies of single institution experiences and state databases (eg, Pennsylvania, New Jersey, New York, Oregon, Washington) have demonstrated the positive role of a statewide trauma system in decreasing mortality [4,5]. Others have demonstrated higher mortality rates for pediatric trauma patients in a rural setting [6], decreased mortality with pediatric intensive care capabilities at receiving centers [7], equivalence in mortality rates with and without pediatric surgery care providers [8][9][10][11][12], increased operative rates and mortality at adult centers [13,14], and improved functional outcome with care in pediatric centers [15]. Such studies have provided helpful indicators, but are limited in power and often reflect regionspecific trauma care patterns.…”

mentioning

confidence: 99%

Outcomes and delivery of care in pediatric injury

Densmore

Lim²,

Oldham

et al. 2006

Journal of Pediatric Surgery

246

105

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Trauma score versus revised trauma score in TRISS to predict outcome in children with blunt trauma

Cited by 37 publications

References 14 publications

Multicenter Validation of the Philadelphia EMS Admission Rule (PEAR) to Predict Hospital Admission in Adult Patients Using Out‐of‐hospital Data

Multicenter Validation of the Philadelphia EMS Admission Rule (PEAR) to Predict Hospital Admission in Adult Patients Using Out‐of‐hospital Data

Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system

Outcomes and delivery of care in pediatric injury

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