New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study

被引:8
作者
Gang, Min Chul [1 ]
Hong, Ki Jeong [1 ]
Shin, Sang Do [1 ]
Song, Kyoung Jun [1 ]
Ro, Young Sun [2 ]
Kim, Tae Han [3 ]
Park, Jeong Ho [1 ]
Jeong, Joo [4 ]
机构
[1] Seoul Natl Univ, Seoul Natl Univ Hosp, Dept Emergency Med, Coll Med, Seoul, South Korea
[2] Seoul Natl Univ Hosp, Lab Emergency Med Serv, Biomed Res Inst, Seoul, South Korea
[3] Seoul Natl Univ, Dept Emergency Med, Boramae Med Ctr, Seoul, South Korea
[4] Seoul Natl Univ, Dept Emergency Med, Bundang Hosp, Seongnam, South Korea
关键词
Brain injuries; traumatic; Mortality; Disability; Quality improvement; Prehospital; OF-HOSPITAL HYPOTENSION; RESPIRATORY RATE; UNITED-STATES; ARTERIAL-PRESSURE; PULSE OXIMETRY; BLOOD-PRESSURE; ACCURACY; PATIENT; DISCHARGE; CARE;
D O I
10.15441/ceem.18.027
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability. Methods We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure <90 mmHg, peripheral capillary oxygen saturation <90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS. Results In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P<0.01). Conclusion Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.
引用
收藏
页码:152 / 159
页数:8
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