1
|
Zhuang Q, Liu J, Liu W, Ye X, Chai X, Sun S, Feng C, Li L. Development and validation of risk prediction model for adverse outcomes in trauma patients. Ann Med 2024; 56:2391018. [PMID: 39155796 PMCID: PMC11334749 DOI: 10.1080/07853890.2024.2391018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND The prognosis of trauma patients is highly dependent on early medical diagnosis. By constructing a nomogram model, the risk of adverse outcomes can be displayed intuitively and individually, which has important clinical implications for medical diagnosis. OBJECTIVE To develop and evaluate models for predicting patients with adverse outcomes of trauma that can be used in different data availability settings in China. METHODS This was a retrospective prognostic study using data from 8 public tertiary hospitals in China from 2018. The data were randomly divided into a development set and a validation set. Simple, improved and extended models predicting adverse outcomes were developed, with adverse outcomes defined as in-hospital death or ICU transfer, and patient clinical characteristics, vital signs, diagnoses, and laboratory test values as predictors. The results of the models were presented in the form of nomograms, and performance was evaluated using area under the receiver operating characteristic curve (ROC-AUC), precision-recall (PR) curves (PR-AUC), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis (DCA). RESULTS Our final dataset consisted of 18,629 patients (40.2% female, mean age of 52.3), 1,089 (5.85%) of whom resulted in adverse outcomes. In the external validation set, three models achieved ROC-AUC of 0.872, 0.881, and 0.903, and a PR-AUC of 0.339, 0.337, and 0.403, respectively. In terms of the calibration curves and DCA, the models also performed well. CONCLUSIONS This prognostic study found that three prediction models and nomograms including the patient clinical characteristics, vital signs, diagnoses, and laboratory test values can support clinicians in more accurately identifying patients who are at risk of adverse outcomes in different settings based on data availability.
Collapse
Affiliation(s)
- Qian Zhuang
- Department of Innovative Medical Research, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jianchao Liu
- Department of Innovative Medical Research, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Wei Liu
- Department of Innovative Medical Research, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Xuan Chai
- Outpatient Department, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Songmei Sun
- The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Cong Feng
- Department of Emergency, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Li
- Department of Innovative Medical Research, Chinese People’s Liberation Army General Hospital, Beijing, China
| |
Collapse
|
2
|
Kenarangi T, Rahmani F, Yazdani A, Ahmadi GD, Lotfi M, Khalaj TA. Comparison of GAP, R-GAP, and new trauma score (NTS) systems in predicting mortality of traffic accidents that injure hospitals at Mashhad University of medical sciences. Heliyon 2024; 10:e36004. [PMID: 39224324 PMCID: PMC11366929 DOI: 10.1016/j.heliyon.2024.e36004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Background There are several trauma scoring systems with varying levels of accuracy and reliability that have been developed to predict and classify mortality in trauma patients in the hospital admission. Considering the importance of the country's emergency organization and the World Health Organization in the category of traffic accidents, we used this information in the study. The objective of this study is to evaluate and compare the predictive power of three scoring systems (R-GAP, GAP, and NTS) on traffic accident injuries. Methods In an analytical cross-sectional study, all the data related to the mission of traffic accidents at the pre-hospital emergency management of Mashhad University of Medical Sciences in 2022 were extracted from the automation system, and the outcome of the patients in the hospital was recorded from the integrated hospital system. Then, GAP, R-GAP, and New Trauma Scores (NTS) were calculated, and their results were compared using ROC curve and logistic regression. Results In this study, 47,971 injuries from traffic accidents were evaluated. Their average age was 30.16 ± 10.93 years. R-GAP showed negligible difference than GAP and NTS scores (the area under the curve equals 0.904, 0.935, and 0.884, respectively), and the average scores of R-GAP, GAP, and NTS are equal to 22.45/45 ± 1/9, 22.25 ± 1.5, and 22.49 ± 1.3, respectively. Injury severity based on R-GAP, GAP, and NTS scores was mild in most patients. The effect of these models on the patient outcome based on OR values, R-GAP, GAP, and NTS models showed high values. All analysis was performed in SPSS 26. Conclusion According to the study results, it seems that R-GAP, GAP, and NTS, have the highest power to predict death in traffic accident injuries. It is recommended to include these points in the electronic file of the pre-hospital emergency for the injured. Also, the severity and outcome of the patient can be predicted by these scores, which play an important role in the triage of the injured and determining the appropriate treatment center.
Collapse
Affiliation(s)
- Taiebe Kenarangi
- Department of Biostatistics and Epidemiology, Faculty of Statistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Statistics, Emergency Medical Services, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Rahmani
- Associate Professor of Emergency Medicine, Road Traffic Injury Prevention Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Yazdani
- Head of Prehospital Emergency Medical Services, Emergency Medical Services, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghazaleh Doustkhah Ahmadi
- Department of Research, Emergency Medical Services, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Lotfi
- Executive Vice President, Emergency Medical Services, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Toktam Akbari Khalaj
- Department of Statistics, Emergency Medical Services, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
3
|
Becker N, Hammen A, Bläsius F, Weber CD, Hildebrand F, Horst K. Effect of Injury Patterns on the Development of Complications and Trauma-Induced Mortality in Patients Suffering Multiple Trauma. J Clin Med 2023; 12:5111. [PMID: 37568511 PMCID: PMC10420136 DOI: 10.3390/jcm12155111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Patients that suffer from severe multiple trauma are highly vulnerable to the development of complications that influence their outcomes. Therefore, this study aimed to evaluate the risk factors that can facilitate an early recognition of adult patients at risk. The inclusion criteria were as follows: admission to a level 1 trauma center, injury severity score (ISS) ≥ 16 (severe injury was defined by an abbreviated injury score (AIS) ≥ 3) and ≥18 years of age. Injury- and patient-associated factors were correlated with the development of four complication clusters (surgery-related, infection, thromboembolic events and organ failure) and three mortality time points (immediate (6 h after admission), early (>6 h-72 h) and late (>72 h) mortality). Statistical analysis was performed using a Chi-square, Mann-Whitney U test, Cox hazard regression analysis and binominal logistic regression analysis. In total, 383 patients with a median ISS of 24 (interquartile range (IQR) 17-27) were included. The overall mortality rate (27.4%) peaked in the early mortality group. Lactate on admission significantly correlated with immediate and early mortality. Late mortality was significantly influenced by severe head injuries in patients with a moderate ISS (ISS 16-24). In patients with a high ISS (≥25), late mortality was influenced by a higher ISS, older age and higher rates of organ failure. Complications were observed in 47.5% of all patients, with infections being seen most often. The development of complications was significantly influenced by severe extremity injuries, the duration of mechanical ventilation and length of ICU stay. Infection remains the predominant posttraumatic complication. While immediate and early mortality is mainly influenced by the severity of the initial trauma, the rates of severe head injuries influence late mortality in moderate trauma severity, while organ failure remains a relevant factor in patients with a high injury severity.
Collapse
Affiliation(s)
- Nils Becker
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Antonia Hammen
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University Hospital Aachen, 52074 Aachen, Germany
| | - Felix Bläsius
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Christian David Weber
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| | - Klemens Horst
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany; (N.B.)
| |
Collapse
|
4
|
Jokšić-Mazinjanin R, Marić N, Đuričin A, Gojković Z, Vasović V, Rakić G, Jokšić-Zelić M, Saravolac S. Prehospital Trauma Scoring Systems for Evaluation of Trauma Severity and Prediction of Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050952. [PMID: 37241183 DOI: 10.3390/medicina59050952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/22/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Trauma scoring systems in prehospital settings are supposed to ensure the most appropriate in-hospital treatment of the injured. AIM OF THE STUDY To determine the sensitivity and specificity of the CRAMS scale (circulation, respiration, abdomen, motor and speech), RTS score (revised trauma score), MGAP (mechanism, Glasgow Coma Scale, age, arterial pressure) and GAP (Glasgow Coma Scale, age, arterial pressure) scoring systems in prehospital settings in order to evaluate trauma severity and to predict the outcome. MATERIALS AND METHODS A prospective, observational study was conducted. For every trauma patient, a questionnaire was initially filled in by a prehospital doctor and these data were subsequently collected by the hospital. RESULTS The study included 307 trauma patients with an average age of 51.7 ± 20.9. Based on the ISS (injury severity score), severe trauma was diagnosed in 50 (16.3%) patients. MGAP had the best sensitivity/specificity ratio when the obtained values indicated severe trauma. The sensitivity and specificity were 93.4 and 62.0%, respectively, for an MGAP value of 22. MGAP and GAP were strongly correlated with each other and were statistically significant in predicting the outcome of treatment (OR 2.23; 95% Cl 1.06-4.70; p = 0.035). With a rise of one in the MGAP score value, the probability of survival increases 2.2 times. CONCLUSION MGAP and GAP, in prehospital settings, had higher sensitivity and specificity when identifying patients with a severe trauma and predicting an unfavorable outcome than other scoring systems.
Collapse
Affiliation(s)
- Radojka Jokšić-Mazinjanin
- Department of Emergency Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| | - Nikolina Marić
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| | - Aleksandar Đuričin
- Department of Emergency Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| | - Zoran Gojković
- Department of Surgery, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Vojvodina, 21137 Novi Sad, Serbia
| | - Velibor Vasović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Goran Rakić
- Department of Emergency Medicine, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Intensive Surgical Therapy, Institute for Child and Youth Health Care Vojvodina, Pediatric Surgery Clinic, 21000 Novi Sad, Serbia
| | | | - Siniša Saravolac
- Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia
| |
Collapse
|
5
|
Khafafi B, Garkaz O, Golfiroozi S, Paryab S, Ashouri L, Daei S, Mehryar H, Ghelichi-Ghojogh M. Comparison the Ability of Quantitative Trauma Severity Assessment Methods Based On GAP, RTS, and ISS Criteria in Determining the Prognosis of Accidental Patients. Bull Emerg Trauma 2022; 10:122-127. [PMID: 35991372 PMCID: PMC9373053 DOI: 10.30476/beat.2022.94794.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the ability of quantitative trauma severity assessment methods based on Glasgow coma scale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria in determining the prognosis of accidental patients. Methods This cross-sectional study was performed on random patients referred to Imam Khomeini Hospital in Urmia from March 20, 2020 to September 21, 2020. The data were obtained by using a checklist includes items such as age, sex, respiration rate, oxygen saturation level, pulse rate, primary blood pressure, initial Glascow coma scale (GCS), patient outcome and injury to different parts of body. After collecting the data, it was entered into SPSS 18 and analyzed with the descriptive and analytical statistics include an independent t-test and receiver operating characteristic curve (ROC) curves. Results Out of 1930 studied patients, 365 (18.9%) were women and 1565 (81.1%) were men. The mean age of patients was 37.05±17.11 years and women were significantly older than men. The mortality rate was 4.8% and was significantly more in men compared to women. The mean blood pressure, GCS and oxygen saturation level were lower in deceased patients. The mean GAP, ISS and RTS values were 23.13±2.69, 4.07±3.82, 7.72±0.52, respectively. The mean values of GAP and RTS were significantly low in deceased patients whereas the mean ISS value was significantly high in the deceased patients. The Area under the curve (AUS) for ISS was greater than the other two scoring systems. Conclusion The findings of the current study showed that all three systems were adequately efficient to prognoses the final outcome in multi-trauma patients but the ISS measure was better than the other two criteria.
Collapse
Affiliation(s)
- Behrang Khafafi
- Department of Emergency Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Omid Garkaz
- School of Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Saeed Golfiroozi
- Department of Emergency Medicine, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sahar Paryab
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Laia Ashouri
- General Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Sevda Daei
- General Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamidreza Mehryar
- Department of Emergency Medicine, Urmia University of Medical Sciences, Urmia, Iran,Corresponding author: Hamidreza Mehryar, Address: Assistant Professor of Emergency Medicine, Urmia University of Medical Sciences, Urmia, Iran. e-mail:
| | | |
Collapse
|