Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score

Critical Care

Ichiro Kukita⁴  E Francis Cook¹  Yasuharu Tokuda²  Kiyotaka Kohshi⁵  Toshikazu Abe³  Yutaka Kondo⁴ 

[1] Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA;Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-2-7, Miyamachi, Mito City, Ibaraki 310-0015, Japan;Department of Emergency Medicine, Mito Kyodo General Hospital, University of Tukuba, 3-2-7, Miyamachi, Mito City, Ibaraki 310-0015, Japan;Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan;Emergency Unit, University Hospital of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan

关键词: scoring system;    hospital mortality;    factual;    databases;    research design;    trauma;    wounds and injuries;   

Others  :  1094107
DOI  :  10.1186/cc10348

 received in 2011-05-10, accepted in 2011-08-10,  发布年份 2011

【 摘 要 】

Introduction

Our aim in this study was to assess whether the new Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, which is a modification of the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) scoring system, better predicts in-hospital mortality and can be applied more easily than previous trauma scores among trauma patients in the emergency department (ED).

Methods

This multicenter, prospective, observational study was conducted to analyze readily available variables in the ED, which are associated with mortality rates among trauma patients. The data used in this study were derived from the Japan Trauma Data Bank (JTDB), which consists of 114 major emergency hospitals in Japan. A total of 35,732 trauma patients in the JTDB from 2004 to 2009 who were 15 years of age or older were eligible for inclusion in the study. Of these patients, 27,154 (76%) with complete sets of important data (patient age, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), respiratory rate and Injury Severity Score (ISS)) were included in our analysis. We calculated weight for the predictors of the GAP scores on the basis of the records of 13,463 trauma patients in a derivation data set determined by using logistic regression. Scores derived from four existing scoring systems (Revised Trauma Score, Triage Revised Trauma Score, Trauma and Injury Severity Score and MGAP score) were calibrated using logistic regression models that fit in the derivation set. The GAP scoring system was compared to the calibrated scoring systems with data from a total of 13,691 patients in a validation data set using c-statistics and reclassification tables with three defined risk groups based on a previous publication: low risk (mortality < 5%), intermediate risk, and high risk (mortality > 50%).

Results

Calculated GAP scores involved GCS score (from three to fifteen points), patient age < 60 years (three points) and SBP (> 120 mmHg, six points; 60 to 120 mmHg, four points). The c-statistics for the GAP scores (0.933 for long-term mortality and 0.965 for short-term mortality) were better than or comparable to the trauma scores calculated using other scales. Compared with existing instruments, our reclassification tables show that the GAP scoring system reclassified all patients except one in the correct direction. In most cases, the observed incidence of death in patients who were reclassified matched what would have been predicted by the GAP scoring system.

Conclusions

The GAP scoring system can predict in-hospital mortality more accurately than the previously developed trauma scoring systems.

【 授权许可】

   
2011 Kondo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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