qSOFA Score for trauma mortality prediction
Original Article
Keywords:
Organ Dysfunction Scores, trauma Severity indices, multiple trauma, triage, Emergency Medical ServicesAbstract
Introduction: Predicting mortality at the accident site is essential to ensure that all patients with severe trauma are transferred to trauma hospitals while minimizing the unnecessary transport of less severely ill patients to this canter. Objective: Evaluate the discriminatory ability of the prehospital qSOFA score for in-hospital mortality in trauma patients, in comparison with the RTS, T-RTS, MGAP, and GAP scores. Methods: Retrospective single-center study using data from 504 patients >18 years of age with trauma attended by prehospital personnel of the Marco Vinicio Iza General Hospital. The measure of vital signs on the scene was included, to later establish each of the scores. We compared survivors and non-survivors using the t-test for continuous variables and the chi-square test for categorical variables and. The precision of each score for predicting mortality was calculated using the area under the receiver operating characteristic curve (AUROC). Results: All scoring systems demonstrated good to excellent precision for predicting in-hospital mortality, however, better discrimination of the qSOFA score was evidenced with AUROC = 0.937 (95% CI: 0.892-0.983). Conclusion: A direct association between the prehospital qSOFA score and in-hospital mortality was demonstrated in trauma patients. This high level of sensitivity and specificity, superior to the RTS, T-RTS, MGAP, and GAP scores, suggests that the qSOFA score would be a very useful tool in pre-hospital care for trauma triage in our setting.
References
Magruder KM, McLaughlin KA, Elmore Borbon DL. Trauma is a public health issue. Eur J Psychotraumatol. 2017;8(1):1375338. doi:10.1080/20008198.2017.1375338.
WHO. Injuries and violence: the facts: World Health Organization. [Online].; 2010 [cited 2020 agosto 26].
Franklin RC, Sleet DA. Injury prevention and health promotion: A global perspective [published correction appears in Health Promot J Austr. 2018 Dec;29(3):368]. Health Promot J Austr. 2018;29(2):113-116. doi:10.1002/hpja.191.
MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366-378. doi:10.1056/NEJMsa052049.
Galvagno SM Jr, Massey M, Bouzat P, et al. Correlation between the revised trauma score and injury severity score: Implications for prehospital trauma triage. Prehosp Emerg Care. 2019;23(2):263-270. doi:10.1080/10903127.2018.1489019.
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(4):R191. doi:10.1186/cc10348.
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):187-196.
Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623-629. doi:10.1097/00005373-198905000-00017.
Husum H, Strada G. Injury severity score versus new injury severity score for penetrating injuries. Prehosp Disaster Med. 2002;17(1):27-32. doi:10.1017/s1049023x0000008x.
Bouzat P, Legrand R, Gillois P, et al. Prediction of intra-hospital mortality after severe trauma: which pre-hospital score is the most accurate?. Injury. 2016;47(1):14-18. doi:10.1016/j.injury.2015.10.035.
Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27(4):370-378.
Alvarez B, Razente D, Lacerda D, Lother N, VON-Bahten L, Stahlschmidt C. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Rev Col Bras Cir. 2016; 43(5): p. 334-340. doi.org/10.1590/0100-69912016005010.
Sartorius D, Le Manach Y, David JS, 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(3):831-837. doi:10.1097/CCM.0b013e3181cc4a67.
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287.
Shu E, Ives Tallman C, Frye W, et al. Pre-hospital qSOFA as a predictor of sepsis and mortality. Am J Emerg Med. 2019;37(7):1273-1278. doi:10.1016/j.ajem.2018.09.025.
Singer AJ, Ng J, Thode HC Jr, Spiegel R, Weingart S. Quick SOFA Scores predict mortality in adult Emergency Department patients with and without suspected infection. Ann Emerg Med. 2017;69(4):475-479. doi:10.1016/j.annemergmed.2016.10.007.
Jawa RS, Vosswinkel JA, McCormack JE, et al. Risk assessment of the blunt trauma victim: The role of the quick Sequential Organ Failure Assessment Score (qSOFA). Am J Surg. 2017;214(3):397-401. doi:10.1016/j.amjsurg.2017.05.011.
Miyamoto K, Shibata N, Nakashima T, Kato S. Prehospital quick sequential organ failure assessment as a tool to predict in-hospital mortality. Am J Emerg Med. 2018;36(10):1832-1836. doi:10.1016/j.ajem.2018.02.009.
Freund Y, Lemachatti N, Krastinova E, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-hospital mortality among patients with suspected infection presenting to the Emergency Department. JAMA. 2017;317(3):301-308. doi:10.1001/jama.2016.20329.
Miyamoto K, Shibata N, Ogawa A, Nakashima T, Kato S. Prehospital quick sequential organ failure assessment score to predict in-hospital mortality among patients with trauma. Am J Emerg Med. 2019;37(12):2165-2170. doi:10.1016/j.ajem.2019.03.007.
Miyamoto K, Shibata N, Ogawa A, Nakashima T, Kato S. Prehospital and in-hospital quick Sequential Organ Failure Assessment (qSOFA) scores to predict in-hospital mortality among trauma patients: an analysis of nationwide registry data. Acute Med Surg. 2020;7(1):e532. doi:10.1002/ams2.532.
Galarza-Velasteguí LA, Merino-Salazar P, Algora-Buenafé A. Estudio geoespacial de los accidentes de tránsito en la región Amazónica ecuatoriana. CienciAmérica. 2017; 6(2): p. 31-36.
Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. International comparison of regional trauma registries. Injury. 2012;43(11):1924-1930. doi:10.1016/j.injury.2012.08.024.
Latten GHP, Spek M, Muris JWM, Cals JWL, Stassen PM. Accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and its effect on the outcomes of clinical prediction/diagnostic rules. PLoS One. 2019;14(10):e0223155. doi:10.1371/journal.pone.0223155.
Galarza-Velasteguí LA, Merino-Salazar P, Algora-Buenafé A. Estudio geoespacial de los accidentes de tránsito en la Región Amazónica Ecuatoriana. CienciAmérica. 2017; 6(2): p. 31-36.
Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. International comparison of regional trauma registries. Injury. 2012;43(11):1924-1930. doi:10.1016/j.injury.2012.08.024.
Latten GHP, Spek M, Muris JWM, Cals JWL, Stassen PM. Accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and its effect on the outcomes of clinical prediction/diagnostic rules. PLoS One. 2019;14(10):e0223155. doi:10.1371/journal.pone.0223155.
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