The Operating Characteristics of Vital Signs and Metabolic Parameters in Detecting Major Injury in Trauma Patients

2004 ◽  
Vol 11 (5) ◽  
pp. 512-513
Author(s):  
R. Sinert
Keyword(s):  
Vital Signs ◽  
Metabolic Parameters ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Major Injury

Prehospital Variables Alone Can Predict Mortality After Blunt Trauma: A Novel Scoring Tool

2021 ◽  
pp. 000313482110241
Author(s):  
Stephen Stopenski ◽  
Areg Grigorian ◽  
Kenji Inaba ◽  
Michael Lekawa ◽  
Kazuhide Matsushima ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Vital Signs ◽  
Weighted Average ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Improvement Program ◽  
Logistic Regression Models ◽  
Revised Trauma Score ◽  
Activation Criterion ◽  
Scoring Tool

Background We sought to develop a novel Prehospital Injury Mortality Score (PIMS) to predict blunt trauma mortality using only prehospital variables. Study Design The 2017 Trauma Quality Improvement Program database was queried and divided into two equal sized sets at random (derivation and validation sets). Multiple logistic regression models were created to determine the risk of mortality using age, sex, mechanism, and trauma activation criterion. The PIMS was derived using the weighted average of each independent predictor. The discriminative power of the scoring tool was assessed by calculating the area under the receiver operating characteristics (AUROC) curve. The PIMS ability to predict mortality was then assessed by using the validation cohort. The score was compared to the Revised Trauma Score (RTS) using the AUROC curve, including a subgroup of patients with normal vital signs. Results The derivation and validation groups each consisted of 163 694 patients. Seven independent predictors of mortality were identified, and the PIMS was derived with scores ranging from 0 to 20. The mortality rate increased from 1.4% to 43.9% and then 100% at scores of 1, 10, and 19, respectively. The model had very good discrimination with an AUROC of .79 in both the derivation and validation groups. When compared to the RTS, the AUROC were similar (.79 vs. .78). On subgroup analysis of patients with normal prehospital vital signs, the PIMS was superior to the RTS (.73 vs. .56). Conclusion The PIMS is a novel scoring tool to predict mortality in blunt trauma patients using prehospital variables. It had improved discriminatory power in blunt trauma patients with normal vital signs compared to the RTS.

scholarly journals Early Warning Scores at time of ICU admission to Predict Mortality in critically ill COVID-19 Patients

2021 ◽  
pp. 1-15
Author(s):  
Asha Tyagi ◽  
Surbhi Tyagi ◽  
Ananya Agrawal ◽  
Aparna Mohan ◽  
Devansh Garg ◽  
...  
Keyword(s):  
Developing Country ◽  
Cox Regression ◽  
Vital Signs ◽  
Developed Countries ◽  
Operating Characteristics ◽  
Icu Mortality ◽  
Prospective Data ◽  
Icu Admission ◽  
Reactive Protein ◽  
Time Of Admission

Abstract Objective: To assess ability of NEWS2, SIRS, qSOFA and CRB-65 calculated at the time of Intensive Care Unit (ICU) admission for predicting ICU-mortality in patients of laboratory confirmed COVID-19 infection. Methods: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1month period. The NEWS2, CURB-65, qSOFA and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. Results: Total of 140 patients aged between 18 to 95 years were included in the analysis of whom majority were >60 years (47.8%), with evidence of pre-existing comorbidities (67.1%). The commonest symptom at presentation was dyspnea (86.4%). Based upon the Receiver Operating Characteristics-Area Under Curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB65 (AUC: 0.720 [95% CI: 0.630 – 0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622 – 0.803]). Additionally, a multivariate cox regression model showed Glasgow Coma Score at time of admission [P < 0.001; adjusted Hazard Ratio = 0.808 (95% CI: 0.715-0.911)] to be the only significant predictor of ICU mortality. Conclusion: CRB65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID disease. Since the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

scholarly journals Validation and modification of existing mortality prediction model for lower gastrointestinal bleeding: A retrospective study

2021 ◽  
Author(s):  
Hyun Suk Lee ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Hyun Yong Jeong ◽  
Byung Seok Lee ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Confidence Interval ◽  
Gastrointestinal Bleeding ◽  
Scoring System ◽  
Vital Signs ◽  
International Normalized Ratio ◽  
Mortality Prediction ◽  
Lower Gastrointestinal Bleeding ◽  
Operating Characteristics ◽  
Related Mortality

Abstract Background Lower gastrointestinal bleeding (LGIB) often subsides by itself; however, in some cases, the bleeding does not stop and the patient’s condition worsens. Therefore, if the occurrence of severe lower gastrointestinal bleeding can be predicted in advance, it can be helpful for treatment. This study aimed to evaluate variables related to mortality from LGIB and to propose a scoring system. Methods This retrospective study reviewed the medical records of patients who visited the emergency room with hematochezia between January 2016 and December 2020. Through regression analysis of vital signs, laboratory investigations, and hospital stay, variables related to LGIB-related mortality were evaluated. A scoring system was developed, and the appropriateness with an area under the receiver operating characteristics curve (AUROC) was evaluated and compared with other existing models. Results A total of 932 patients were hospitalized for LGIB. Variables associated with LGIB-related mortality were the presence of cancer, heart rate of > 100 beats/min, blood urea nitrogen level of ≥ 30 mg/dL, an international normalized ratio of > 1.50, and albumin level of ≤ 3.0 g/dL. The AUROCs of CNUH-4 and CNUH-5 were 0.890 (p < 0.001; cutoff, 2.5; 95% confidence interval, 0.0851 − 0.929) and 0.901 (p < 0.001; cutoff, 3.5; 95% confidence interval, 0.869 − 0.933), respectively. Conclusions The model developed for predicting the risk of LGIB-related mortality is simple and easy to apply clinically. The AUROC of the model was better than that of the existing models.

Abstract 343: Prediction of Lifesaving Interventions Using Changes in Vital Signs from Prehospital Scene to Emergency Department

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jorge H Mena Munoz ◽  
Ashley Petersen ◽  
Francis X Guyette
Keyword(s):  
Emergency Department ◽  
Decision Trees ◽  
Recursive Partitioning ◽  
Vital Signs ◽  
Large Change ◽  
Predictive Performance ◽  
Classification Performance ◽  
Secondary Outcome ◽  
Classification Error ◽  
Trauma Patients

Objective: We investigate whether changes in vital signs between the prehospital scene and emergency department (ED) can be used to develop triage tools to predict the need for life-saving interventions (LSI) and survival in trauma patients. Methods: We analyzed a prospective cohort with any prehospital systolic blood pressure (SBP) ≤ 90 mmHg or Glasgow Coma Scale ≤ 8 who were admitted to an ED at 11 sites of the Resuscitation Outcomes Consortium. The primary outcome was the need for in-hospital LSI (e.g. invasive airway management, invasive bleeding control, blood transfusion, craniotomy, cardiopulmonary resuscitation). Secondary outcome was survival to hospital discharge. Changes in heart rate (HR), SBP, shock index (SI), and respiratory rate (RR) from first prehospital assessment to first ED assessment were considered as predictors in addition to sex, age, mechanism of injury, trauma center level, duration of transport, type of transport, and prehospital fluid volume. Decision trees for each outcome were developed using binary recursive partitioning with predictive performance measured using sensitivity, specificity, and classification error. Results: 5625 subjects were included in our analysis with 49% in need of LSI and 21% dying prior to discharge. Patients needing an LSI tended to either: (1) have an increasing SI (delta ≥ 0.22), (2) have a decreasing SI (delta < 0.22) and >500 mL prehospital fluids, or (3) have a decreasing SI (delta < 0.22), ≤500 mL prehospital fluids, and large change in RR (delta ≥ 9.5 or delta < -7.5). Those surviving to discharge tended to either: (1) have a decreasing SI (delta < 0.57) and a HR that did not decrease greatly (delta > -47) or (2) have an increase in SI (0.57 ≤ delta < 1) and a declining RR (delta < 5). LSI tree had a sensitivity of 58.7% and specificity of 63.3%. Survival tree had sensitivity of 96.2% and specificity of 21.3%. Conclusion: Though the decision trees were constructed with the best data in terms of initial triage and early secondary triage, the classification performance was limited. This highlights the difficulties of developing vital sign based triage tools to predict the need for LSI and survival.

Validation of a Novel Clinical Criteria to Predict Candidacy for Aortic Occlusion: An Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Study

2020 ◽  
Vol 86 (10) ◽  
pp. 1418-1423
Author(s):  
Reynold Henry ◽  
Kazuhide Matsushima ◽  
Rachel N. Henry ◽  
Gregory A. Magee ◽  
Christoper P. Foran ◽  
...  
Keyword(s):  
Acute Care ◽  
Vital Signs ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Acute Care Surgery ◽  
Trauma Patients ◽  
Clinical Criteria ◽  
Resuscitative Thoracotomy ◽  
Control Procedures ◽  
Care Surgery

For trauma patients with noncompressible truncal hemorrhage (NCTH), aortic occlusion (AO) is attempted with either resuscitative thoracotomy (RT) or the resuscitative endovascular balloon occlusion of the aorta (REBOA). However, it is often challenging to identify the group of patients who would benefit from AO procedures. We hypothesized that patients who met simple clinical criteria would have better outcomes following AO procedures. This is a retrospective cohort study using the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database (November 2013-August 2019) which included patients who arrived with signs of life and underwent AO procedures (RT or zone 1 REBOA). Outcomes were compared between patients who met the criteria (admission vital signs: Glasgow Coma Scale (GCS) ≥9 and systolic blood pressure <90 mm Hg) and those who did not. Subgroup analyses were then conducted on patients who had a REBOA placed and those who underwent RT. A total of 998 patients met our inclusion criteria. Of those, a REBOA was placed in 364 patients (37%), while 634 (64%) underwent RT. The overall mortality rate in the criteria (+) group was significantly lower than that in the criteria (−) group (62 vs. 79%, P < .001). In patients who survived beyond the emergency department following AO procedures, those who met the criteria underwent hemorrhage control procedures more frequently (83% vs. 57%, P < .001). Our data suggest that simple clinical criteria could guide the provider for proceeding with AO in patients with suspected NCTH.

Validation of the COAST score for predicting acute traumatic coagulopathy: A retrospective single-centre cohort study

Trauma ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 112-117
Author(s):  
Sophie Thorn ◽  
Martin Tonglet ◽  
Marc Maegele ◽  
Russell Gruen ◽  
Biswadev Mitra
Keyword(s):  
Cohort Study ◽  
Early Identification ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Hospital Data ◽  
Single Centre ◽  
Acute Traumatic Coagulopathy ◽  
Simple Method ◽  
Traumatic Coagulopathy

Purpose Early identification of trauma patients at risk of developing acute traumatic coagulopathy is important in initiating appropriate, coagulopathy-focused treatment. A clinical acute traumatic coagulopathy prediction tool is a quick, simple method to evaluate risk. The COAST score was developed in Australia and we hypothesised that it could predict coagulopathy and bleeding-related adverse outcomes in other advanced trauma systems. We validated COAST on a single-centre cohort of trauma patients from a trauma centre in Belgium. Methods The COAST score was modified to suit available data; we used entrapment, blood pressure, temperature, major chest injury and abdominal injury to calculate the score. Acute traumatic coagulopathy was defined as international normalised ratio >1.5 or activated partial thromboplastin time >60 s upon arrival of the patient to the hospital. Data were extracted from the local trauma registry on patients that presented between 1 January and 31 December 2015. Results In all, 133 patients met the inclusion criteria (>16 years old, available COAST and outcome data) for analysis. The COAST score had an area under the receiver operating characteristics curve of 0.941 (95% CI: 0.884–0.999) and at COAST ≥3, it had 80% sensitivity and 96% specificity. The score also identified patients with higher rates of mortality, blood transfusion and emergent surgery. Conclusion This retrospective cohort study demonstrated the utility of the COAST score in identifying trauma patients who are likely to have bleeding-related poor outcomes. The early identification of these patients will facilitate timely, appropriate treatment for acute traumatic coagulopathy and minimise the risk of over-treatment. It can also be used to select patients with acute traumatic coagulopathy for trials involving therapeutic agents targeted at acute traumatic coagulopathy.

Prehospital Vital Signs Accurately Predict Initial Emergency Department Vital Signs

2020 ◽  
Vol 35 (3) ◽  
pp. 254-259
Author(s):  
Marc D. Trust ◽  
Morgan Schellenberg ◽  
Subarna Biswas ◽  
Kenji Inaba ◽  
Vincent Cheng ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intraclass Correlation ◽  
Vital Signs ◽  
Correlation Coefficients ◽  
Trauma Team ◽  
Urban Setting ◽  
Trauma Patients ◽  
Level I ◽  
Gcs Score ◽  
Good Agreement

AbstractIntroduction:Prehospital vital signs are used to triage trauma patients to mobilize appropriate resources and personnel prior to patient arrival in the emergency department (ED). Due to inherent challenges in obtaining prehospital vital signs, concerns exist regarding their accuracy and ability to predict first ED vitals.Hypothesis/Problem:The objective of this study was to determine the correlation between prehospital and initial ED vitals among patients meeting criteria for highest levels of trauma team activation (TTA). The hypothesis was that in a medical system with short transport times, prehospital and first ED vital signs would correlate well.Methods:Patients meeting criteria for highest levels of TTA at a Level I trauma center (2008-2018) were included. Those with absent or missing prehospital vital signs were excluded. Demographics, injury data, and prehospital and first ED vital signs were abstracted. Prehospital and initial ED vital signs were compared using Bland-Altman intraclass correlation coefficients (ICC) with good agreement as >0.60; fair as 0.40-0.60; and poor as <0.40).Results:After exclusions, 15,320 patients were included. Mean age was 39 years (range 0-105) and 11,622 patients (76%) were male. Mechanism of injury was blunt in 79% (n = 12,041) and mortality was three percent (n = 513). Mean transport time was 21 minutes (range 0-1,439). Prehospital and first ED vital signs demonstrated good agreement for Glasgow Coma Scale (GCS) score (ICC 0.79; 95% CI, 0.77-0.79); fair agreement for heart rate (HR; ICC 0.59; 95% CI, 0.56-0.61) and systolic blood pressure (SBP; ICC 0.48; 95% CI, 0.46-0.49); and poor agreement for pulse pressure (PP; ICC 0.32; 95% CI, 0.30-0.33) and respiratory rate (RR; ICC 0.13; 95% CI, 0.11-0.15).Conclusion:Despite challenges in prehospital assessments, field GCS, SBP, and HR correlate well with first ED vital signs. The data show that these prehospital measurements accurately predict initial ED vitals in an urban setting with short transport times. The generalizability of these data to settings with longer transport times is unknown.

‘Normal’ Vital Signs Belie Occult Hypoperfusion in Geriatric Trauma Patients

2010 ◽  
Vol 76 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Jeremiah T. Martin ◽  
Fuad Alkhoury ◽  
Judith A. O'Connor ◽  
Tassos C. Kyriakides ◽  
John A. Bonadies
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Length ◽  
Vital Signs ◽  
Intensive Care Unit Length ◽  
Hospital Length Of Stay ◽  
Common Finding ◽  
Trauma Patients ◽  
Severity Scores

Base deficit (BD) and lactic acid (LA) are accepted markers of hypoperfusion and predictors of outcome in the trauma patient and we aim to assess the value of these markers in the triage of the elderly with “normal” vital signs. Patients older than age 65 who presented between 1997 and 2004 but who did not have isolated head injuries were included. Three patient groups were established: normal, occult hypoperfusion (OH), and shock. Outcome measures included mortality, hospital length of stay, intensive care unit length of stay, and discharge disposition. One hundred six patients were included in the analysis and had similar Injury Severity Scores. Mean systolic blood pressure was similar in the normal and OH groups. Forty-two per cent of patients had abnormal BD or LA in the emergency room indicating OH. These patients were more likely to have a longer intensive care unit length of stay (8.6 days vs 3 days; P = 0.01) and were also more likely to be discharged to a nursing facility ( P = 0.03). The trend was toward increased mortality in the OH group. OH is a common finding in elderly trauma patients. Outcomes in these patients are different and more like those presenting in shock.

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