Gałązkowski Robert, Farkowski Michał M, Rabczenko Daniel, Marciniak-Emmons Marta, Darocha Tomasz, Timler Dariusz, Sterliński Maciej
Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland.
Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
Arch Med Sci. 2018 Jun;14(4):865-870. doi: 10.5114/aoms.2016.61884. Epub 2016 Aug 18.
The Revised Trauma Score (RTS) accurately identifies trauma patients at high risk of adverse events or death. Less is known about its usefulness in the general population and non-trauma recipients of Helicopter Emergency Medical Service (HEMS). The RTS is a simple tool and omits a lot of other data obtained during clinical evaluation. The aim was to assess the role of the RTS to identify patients at risk of major complications (death, cardiopulmonary resuscitation, defibrillation, intubation) in the general population of HEMS patients. Clinical factors beyond the RTS were analyzed to identify additional prognostic factors for predicting major complications.
A retrospective analysis of medical records of adult patients routinely collected during HEMS missions in the years 2011-2014 was performed.
The analysis included 19 554 HEMS missions. Patients were 55 ±20 years old and 68% were male. The most common indication for HEMS was diseases of the circulatory system - 41%. Major complications occurred in 2072 (10.6%) cases. In the general population of HEMS patients, the RTS accurately identified individuals at risk of major complications at a cut-off value of 10.5 and area under the curve (AUC) of 93.5%. In multivariate analysis, additional clinical data derived from clinical examination (ECG; skin, pupil and breathing examination) significantly but marginally improved the accuracy of RTS assessment: AUC 95.6% ( < 0.001 for the difference).
The Revised Trauma Score accurately identifies individuals at risk of major complications during HEMS missions regardless of the indication. Additional clinical data significantly but marginally improved the accuracy of RTS in the general population of HEMS patients.
修订创伤评分（RTS）能准确识别有不良事件或死亡高风险的创伤患者。对于其在直升机紧急医疗服务（HEMS）的普通人群和非创伤患者中的效用，人们了解较少。RTS是一个简单工具，遗漏了临床评估期间获得的许多其他数据。目的是评估RTS在HEMS患者普通人群中识别有重大并发症（死亡、心肺复苏、除颤、插管）风险患者的作用。分析了RTS之外的临床因素，以确定预测重大并发症的其他预后因素。
对2011 - 2014年HEMS任务期间常规收集的成年患者病历进行回顾性分析。
分析包括19554次HEMS任务。患者年龄为55±20岁，68%为男性。HEMS最常见的指征是循环系统疾病——41%。2072例（10.6%）发生了重大并发症。在HEMS患者普通人群中，RTS在临界值为10.5且曲线下面积（AUC）为93.5%时能准确识别有重大并发症风险的个体。在多变量分析中，临床检查（心电图；皮肤、瞳孔和呼吸检查）得出的额外临床数据显著但轻微提高了RTS评估的准确性：AUC为95.6%（差异<0.001）。
修订创伤评分能准确识别HEMS任务期间有重大并发症风险的个体，无论指征如何。额外临床数据显著但轻微提高了RTS在HEMS患者普通人群中的准确性。
