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

Critical Care ◽  
2011 ◽  
Vol 15 (4) ◽  
pp. R191 ◽  
Author(s):  
Yutaka Kondo ◽  
Toshikazu Abe ◽  
Kiyotaka Kohshi ◽  
Yasuharu Tokuda ◽  
E Francis Cook ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Scoring System ◽  
Coma Scale ◽  
Trauma Scoring

scholarly journals Mechanism of Injury, Glasgow Coma Scale, Age, and Systolic Blood Pressure: A New Trauma Scoring System to Predict Mortality in Trauma Patients

2015 ◽  
Vol 20 (3) ◽  
Author(s):  
Iraj Baghi ◽  
Leila Shokrgozar ◽  
Mohamad Rasoul Herfatkar ◽  
Kazem Nezhad Ehsan ◽  
Zahra Mohtasham Amiri
Keyword(s):  
Blood Pressure ◽  
Glasgow Coma Scale ◽  
Systolic Blood Pressure ◽  
Scoring System ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Coma Scale ◽  
Trauma Scoring

scholarly journals Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Atsushi Shiraishi ◽  
Yasuhiro Otomo ◽  
Shunsuke Yoshikawa ◽  
Koji Morishita ◽  
Ian Roberts ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glasgow Coma Scale ◽  
Systolic Blood Pressure ◽  
Respiratory Rate ◽  
Validation Cohort ◽  
Hospital Death ◽  
The Novel ◽  
Coma Scale ◽  
Physiological Variables ◽  
Trauma Score

Abstract Background Multiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score. Methods The study was a retrospective prognostic study. Data from patients registered in the Japan Trauma Databank (JTDB) were dichotomized into derivation and validation cohorts. Patients’ data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial were assigned to another validation cohort. We obtained age and physiological variables at baseline, created ordinal variables from continuous variables, and defined integer weighting coefficients. Score performance to predict all-cause in-hospital death was assessed using the area under the curve in receiver operating characteristics (AUROC) analyses. Results Based on the JTDB derivation cohort (n = 99,867 with 12.5% mortality), the novel score ranged from 0 to 14 points, including 0–2 points for age, 0–6 points for the Glasgow Coma Scale, 0–4 points for systolic blood pressure, and 0–2 points for respiratory rate. The AUROC of the novel score was 0.932 for the JTDB validation cohort (n = 76,762 with 10.1% mortality) and 0.814 for the CRASH-2 cohort (n = 19,740 with 14.6% mortality), which was superior to RTS (0.907 and 0.808, respectively) and MGAP score (0.918 and 0.774, respectively) results. Conclusions We report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.

Should Trauma Patients with a Glasgow Coma Scale Score of 3 Be Intubated Prior to Hospital Arrival?

2010 ◽  
Vol 25 (6) ◽  
pp. 541-546 ◽  
Author(s):  
Charlene B. Irvin ◽  
Susan Szpunar ◽  
Lauren A. Cindrich ◽  
Justin Walters ◽  
Robert Sills
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Logistic Regression ◽  
Glasgow Coma Scale ◽  
Systolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Body Region ◽  
Trauma Patients ◽  
Hospital Arrival ◽  
Prehospital Endotracheal Intubation

AbstractIntroduction:Previous studies of heterogeneous populations (Glasgow Coma Scale (GCS) scores <9) suggest that endotracheal intubaton of trauma patients prior to hospital arrival (i.e., prehospital intubated) is associated with an increased mortality compared to those patients not intubated in the pre-hospital setting. Deeply comatose patients (GCS = 3) represent a unique population of severely traumatized patients and may benefit from intubation in the prehospital setting. The objective of this study was to compare mortality rates of severely comatose patients (scene GCS = 3) with prehospital endotracheal intubation to those intubated at the hospital.Methods:Using the National Trauma Data Bank (V. 6.2), the following variables were analyzed retrospectively: (1) age; (2) injury type (blunt or penetrating); (3) Injury Severity Score (ISS); (4) scene GCS = 3 (scored prior to intubation/without sedation); (5) emergency department GCS score; (6) arrival emergency department intubation status; (7) first systolic blood pressure in the emergency department (>0); (8) discharge status (alive or dead); (9) Abbreviated Injury Scale Score (AIS); and (10) AIS body region.Results:Of the 10,948 patients analyzed, 23% (2,491/10,948) were endotracheally intubated in a prehospital setting. Mortality rate for those hospital intubated was 35% vs. 62% for those with prehospital intubation (p <0.0001); mean ISS scores 24.2 ±16.0 vs. 31.6 ±16.2, respectively (p <0.0001). Using logistic regression, controlling for first systolic blood pressure, ISS, emergency department GCS, age, and type of trauma, those with prehospital intubation were more likely to die (OR = 1.9, 95% CI = 1.7−2.2). For patients with only head AIS scores (no other body region injury, n = 1,504), logistic regression (controlling for all other variables) indicated that those with prehospital intubation were still more likely to die (OR = 2.0. 95% CI = 1.4−2.9).Conclusions:Prehospital endotracheal intubation is associated with an increased mortality in completely comatose trauma patients (GCS = 3). Although the exact reasons for this remain unclear, these results support other studies and suggest the need for future research and re-appraisal of current policies for prehospital intubation in these severely traumatized patients.

The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection

2018 ◽  
Vol 35 (10) ◽  
pp. 619-622 ◽  
Author(s):  
Mats Warmerdam ◽  
Lucia Baris ◽  
Margo van Liebergen ◽  
Annemieke Ansems ◽  
Laura Esteve Cuevas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Older Patients ◽  
Tissue Perfusion ◽  
Case Mix ◽  
Suspected Infection ◽  
Resuscitation Guidelines

ObjectiveIn existing risk stratification and resuscitation guidelines for sepsis, a hypotension threshold of systolic blood pressure (SBP) below 90–100 mmHg is typically used. However, for older patients, the clinical relevance of a SBP in a seemingly ‘normal’ range (>100 mmHg) is still poorly understood, as they may need higher SBP for adequate tissue perfusion due to arterial stiffening. We therefore investigated the association between SBP and mortality in older emergency department (ED) patients hospitalised with a suspected infection.MethodsIn this observational multicentre study in the Netherlands, we interrogated an existing prospective database of consecutive ED patients hospitalised with a suspected infection between 2011 and 2016. We investigated the association between SBP categories (≤100, 101–120, 121–139, ≥140 mmHg) and in-hospital mortality in patients of 70 years and older. We adjusted for demographics, comorbidity, disease severity and admission to ward/intensive care using multivariable logistic regression.ResultsIn the 833 included older patients, unadjusted in-hospital mortality increased from 4.7% (n=359) in SBP ≥140 mmHg to 20.8% (n=96) in SBP ≤100 mmHg. SBP categories were linearly associated with case-mix-adjusted in-hospital mortality. The adjusted ORs (95% CI) for ≤100, 101–120 and 121–139 mmHgcompared with the reference of ≥140 mmHg were 3.8 (1.8 to 7.8), 2.8 (1.4 to 5.5) and 1.9 (0.9 to 3.7), respectively.ConclusionIn older ED patients hospitalised with a suspected infection, we found an inverse linear association between SBP and case-mix-adjusted in-hospital mortality. Our data suggest that the commonly used threshold for hypotension is not clinically meaningful for risk stratification of older ED patients with a suspected infection.

scholarly journals Association of normal systolic blood pressure in the emergency department with higher in‐hospital mortality among hypertensive patients

2019 ◽  
Vol 21 (12) ◽  
pp. 1841-1848 ◽  
Author(s):  
Eyal Klang ◽  
Shelly Soffer ◽  
Moni Shimon Shahar ◽  
Yiftach Barash ◽  
Sara Apter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Hypertensive Patients

scholarly journals Validation of the Full Outline of Unresponsiveness score coma scale in patients clinically suspected to have acute stroke in the emergency department

2017 ◽  
Vol 24 (5) ◽  
pp. 230-236 ◽  
Author(s):  
Tommy Kwok Ping Lee ◽  
Abdul Karim Bin Kitchell ◽  
Axel Yuet Chung Siu ◽  
Ngan Kwan Chen
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Interrater Reliability ◽  
Coma Scale ◽  
Point Increase

Introduction: The Full Outline of Unresponsiveness score coma scale is a recently introduced coma scale. The objectives of this study were to assess the interrater reliability of the Full Outline of Unresponsiveness score coma scale when physicians and nurses in the emergency department apply the Full Outline of Unresponsiveness score on patients clinically suspected to have acute stroke and to look for any association between Full Outline of Unresponsiveness score coma scale and in-hospital mortality. Methods: Prospective study of 105 patients clinically suspected to have acute stroke recruited in an emergency department in a 4-month period. The Full Outline of Unresponsiveness score coma scale and Glasgow Coma Scale of each patient were assessed by one doctor and one nurse independently. The interrater reliability between physicians and nurses using the Full Outline of Unresponsiveness score and Glasgow Coma Scale score was assessed. The association between the Full Outline of Unresponsiveness score coma scale and in-hospital mortality was analysed using logistic regression, controlled for age, sex and diagnosis. Results: Full Outline of Unresponsiveness score had a good interrater reliability when applied to patients suspected to have acute stroke (kappa = 0.742, 95% confidence interval = 0.626–0.858). This was comparable to Glasgow Coma Scale score with a kappa = 0.796 (95% confidence interval = 0.694–0.898). For every 1-point increase in Full Outline of Unresponsiveness score coma scale, a reduction in in-hospital mortality was observed with an odds ratio of 0.76 (95% confidence interval = 0.63–0.91, p = 0.003), controlled for age, sex and diagnosis. Conclusion: The Full Outline of Unresponsiveness score may be a tool that can be used by emergency department doctors and nurses in assessing clinical stroke patients.

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