Sewalt, C.A., Venema, E., Wiegers, E.J.A. et al. (5 more authors) (2020) Trauma models to identify major trauma and mortality in the prehospital setting. British Journal of Surgery, 107 (4). pp. 373-380. ISSN 0007-1323
Abstract
Background
Patients with major trauma might benefit from treatment in a trauma centre, but early identification of major trauma (Injury Severity Score (ISS) over 15) remains difficult. The aim of this study was to undertake an external validation of existing prognostic models for injured patients to assess their ability to predict mortality and major trauma in the prehospital setting.
Methods
Prognostic models were identified through a systematic literature search up to October 2017. Injured patients transported by Emergency Medical Services to an English hospital from the Trauma Audit and Research Network between 2013 and 2016 were included. Outcome measures were major trauma (ISS over 15) and in‐hospital mortality. The performance of the models was assessed in terms of discrimination (concordance index, C‐statistic) and net benefit to assess the clinical usefulness.
Results
A total of 154 476 patients were included to validate six previously proposed prediction models. Discriminative ability ranged from a C‐statistic value of 0·602 (95 per cent c.i. 0·596 to 0·608) for the Mechanism, Glasgow Coma Scale, Age and Arterial Pressure model to 0·793 (0·789 to 0·797) for the modified Rapid Emergency Medicine Score (mREMS) in predicting in‐hospital mortality (11 882 patients). Major trauma was identified in 52 818 patients, with discrimination from a C‐statistic value of 0·589 (0·586 to 0·592) for mREMS to 0·735 (0·733 to 0·737) for the Kampala Trauma Score in predicting major trauma. None of the prediction models met acceptable undertriage and overtriage rates.
Conclusion
Currently available prehospital trauma models perform reasonably in predicting in‐hospital mortality, but are inadequate in identifying patients with major trauma. Future research should focus on which patients would benefit from treatment in a major trauma centre.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 21 Oct 2019 09:55 |
Last Modified: | 16 Dec 2021 11:10 |
Status: | Published |
Publisher: | Wiley |
Refereed: | Yes |
Identification Number: | 10.1002/bjs.11304 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:151758 |