Emergency and Trauma Center, Kameda Medical Center, 929, Higashicho, Kamogawa, Chiba, 296-8602, Japan.
Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Crit Care. 2019 Nov 21;23(1):365. doi: 10.1186/s13054-019-2636-x.
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.
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.
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.
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.
已经开发和验证了多种创伤评分，包括修订后的创伤评分（RTS）和机制、格拉斯哥昏迷评分、年龄和动脉压（MGAP）评分。然而，这些评分计算复杂或对创伤死亡率的预后能力较低。因此，我们旨在开发和验证一种比 RTS 和 MGAP 评分更容易计算且更准确的创伤评分。
该研究是一项回顾性预后研究。从日本创伤数据库（JTDB）登记的患者中获取数据，并将其分为推导队列和验证队列。将来自临床抗纤维蛋白溶解剂在大出血-2（CRASH-2）试验的患者数据分配到另一个验证队列。我们从基线获得年龄和生理变量，将连续变量转换为有序变量，并定义整数权重系数。使用接受者操作特征（ROC）分析中的曲线下面积（AUROC）评估评分对全因住院死亡的预测性能。
基于 JTDB 推导队列（n=99867，死亡率为 12.5%），新评分范围为 0 至 14 分，包括年龄 0-2 分、格拉斯哥昏迷评分 0-6 分、收缩压 0-4 分和呼吸频率 0-2 分。新评分在 JTDB 验证队列（n=76762，死亡率为 10.1%）和 CRASH-2 队列（n=19740，死亡率为 14.6%）中的 AUROC 分别为 0.932 和 0.814，优于 RTS（分别为 0.907 和 0.808）和 MGAP 评分（分别为 0.918 和 0.774）的结果。
我们报告了一种易于使用的创伤评分，与 RTS 和 MGAP 评分相比，对住院死亡率的预后能力更好。需要进一步的研究来测试新评分的临床适用性。
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