Publikationsserver der RWTH Aachen University
Trauma Score - retrospektive Evaluierung eines präklinisch erhobenen Scores
Abstract
dc:descriptionObjective: Scoring systems are designed to obtain an outcome prediction, mostly referring to a patient's mortality prediction. Scoring systems are important instruments to understand and to evaluate the effectiveness and the quality of medical care. The Trauma Score (TS), as an important score based on physiologic parameters, not only used as a triage tool and for estimating patient prognosis, but has also proven to be a means of assessing the quality of trauma care provided. The efficacy of injury evaluation in a prehospital setting with help of the Trauma Score, released by Champion et al., was analysed. One target was to achieve the predictive power of the TS with regard to the patient's discharge status. Especially the influence of severe head injury upon prognosis of trauma patients assessed by the Trauma Score was evaluated. Methods: Data of 1604 trauma patients, treated by emergency physicians in the field during a three-year period, was evaluated retrospectively. Data was analysed by using Wilcoxon-, exact Fisher- and a Chi-Square-Test and even by calculating stepwise regression and correlation analysis. For data-collecting all clinics which had been receiving trauma patients were contacted and all EMS run forms, used to assess patient's status, were explored to get useful data. As far as possible, the achieved information was handled referring to the recommendations for documentation after sustaining severe trauma, verbalised by the International Trauma Anaesthesia and Critical Care Society (ITACCS). Results: 454 patients (312 male/142 female) were included into the study. The overall mortality of the patient collective was 9%. Blunt trauma accounted for most of the admissions (94%); the remainder were due to penetrating trauma (6%). We found a "cut-off-point" of TS=13 to be the critical triage point. Sensitivity for both, TS and Glasgow Coma Scale (GCS), as an integral part of the TS, was 86%. The specificity of the TS and the GCS comported 89% and 87%. The positive predictive value of the TS and the GCS were 45% and 42%, respectively. TS and GCS showed to have a negative predictive value of 98% respectively. No significant difference was found for the mentioned values (p<0,05). The analysis of every single component of each of the two scales (TS and GCS) did show a good correlation due to survival of a trauma. Not one of the components of the TS could correlate better to mortality than the TS itself (R=-0,8073, p=0,0001). The component of the GCS "best motor response" showed to be better correlated to mortality than the total scale (GCS) itself (R=-0,6362, p=0,0001). It was quite evident the TS not be predictive for the patient's discharge status (e.g. permanent disability or handicap). A number of 120 from 454 trauma patients (26,43%) sustained a minor head injury and 74 patients a major head trauma (16%), within 46 (62%) persons were sustaining a severe head trauma (GCS=8). There was significant reduction of probability of survival found for those with severe head injury (57%, p<0,01). Furthermore, there were significant decreased values of TS and GCS (p<0,0001 respectively). 58% (p<0,0001) of the victims who did not survive the first 60 minutes following the traumatic impact, died because of injuries due to neuro-anatomic trauma. Conclusion: The TS shows an adequate predictive performance of mortality and is therefore a valid triage instrument. There was obviously no understatement of severe head injury by the TS. The TS is, however, not suitable for estimating a prediction of morbidity.
Degree
thesis:*- Grantor dc:publisher
- Publikationsserver der RWTH Aachen University
- Year dc:date
- 2004
Author and committee
dc:creator, dc:contributor.*- Author dc:creator
-
- Jansen, Jochen
- Contributors dc:contributor
-
- Kalff, Günter
Subjects
dc:subject × 7Rights
dc:rights- Statement dc:rights
-
- info:eu-repo/semantics/openAccess
- Language dc:language
- ger