Miller Ross T, Nazir Niaman, McDonald Tracy, Cannon Chad M
The University of Kansas School of Medicine, Kansas City, KS, USA.
Department of Preventative Medicine and Public Health, The University of Kansas Medical Center, Kansas City, KS, USA.
Injury. 2017 Sep;48(9):1870-1877. doi: 10.1016/j.injury.2017.04.048. Epub 2017 Apr 25.
Trauma systems currently rely on imperfect and subjective tools to prioritize responses and resources, thus there is a critical need to develop a more accurate trauma severity score. Our objective was to modify the Rapid Emergency Medicine (REMS) Score for the trauma population and test its accuracy as a predictor of in-hospital mortality when compared to other currently used scores, including the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the "Mechanism, Glasgow Coma Scale, Age and Arterial Pressure" (MGAP) score, and the Shock Index (SI) score.
The two-part study design involved both a modification step and a validation step. The first step incorporated a retrospective analysis of a local trauma database (3680 patients) where three components of REMS were modified to more accurately represent the trauma population. Using clinical judgment and goodness-of-fit tests, systolic blood pressure was substituted for mean arterial pressure, the weighting of age was reduced, and the weighting of Glasgow Coma Scale was increased. The second part comprised validating the new modified REMS (mREMS) score retrospectively on a U.S. National Trauma Databank (NTDB) that included 429,711 patients admitted with trauma in 2012. The discriminate power of mREMS was compared to other trauma scores using the area under the receiver operating characteristic (AUC) curve.
Overall the mREMS score with an AUC of 0.967 (95% CI: 0.963-0.971) was demonstrated to be higher than RTS (AUC 0.959 [95% CI: 0.955-0.964]), ISS (AUC 0.780 [95% CI 0.770-0.791]), MGAP (AUC 0.964 [95% CI: 0.959-0.968]), and SI (AUC 0.670 [95% CI: 0.650-0.690]) in predicting in-hospital mortality on the NTDB.
In the trauma population, mREMS is an accurate predictor of in-hospital mortality, outperforming other used scores. Simple and objective, mREMS may hold value in the pre-hospital and emergency department setting in order to guide trauma team responses.
创伤系统目前依赖不完善且主观的工具来确定应对措施和资源的优先级，因此迫切需要开发一种更准确的创伤严重程度评分。我们的目标是针对创伤人群修改快速急诊医学（REMS）评分，并将其作为院内死亡率预测指标的准确性与其他目前使用的评分进行比较，这些评分包括修订创伤评分（RTS）、损伤严重程度评分（ISS）、“机制、格拉斯哥昏迷量表、年龄和动脉压”（MGAP）评分以及休克指数（SI）评分。
这项两部分的研究设计包括修改步骤和验证步骤。第一步纳入了对本地创伤数据库（3680例患者）的回顾性分析，其中对REMS的三个组成部分进行了修改，以更准确地反映创伤人群。通过临床判断和拟合优度检验，用收缩压替代平均动脉压，降低年龄的权重，并增加格拉斯哥昏迷量表的权重。第二部分包括在美国国家创伤数据库（NTDB）上对新修改的REMS（mREMS）评分进行回顾性验证，该数据库包含2012年因创伤入院的429,711例患者。使用受试者操作特征（AUC）曲线下面积将mREMS的鉴别能力与其他创伤评分进行比较。
总体而言，mREMS评分的AUC为0.967（95%CI：0.963 - 0.971），在NTDB上预测院内死亡率时，高于RTS（AUC 0.959 [95%CI：0.955 - 0.964]）、ISS（AUC 0.780 [95%CI 0.770 - 0.791]）、MGAP（AUC 0.964 [95%CI：0.959 - 0.968]）和SI（AUC 0.670 [95%CI：0.650 - 0.690]）。
在创伤人群中，mREMS是院内死亡率的准确预测指标，优于其他使用的评分。mREMS简单且客观，在院前和急诊科环境中可能具有价值，以指导创伤团队的应对措施。
