Department of Emergency Medicine, Adana City Research & Education Hospital, Adana, Turkey.
Department of Emergency Medicine, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Ir J Med Sci. 2023 Aug;192(4):1855-1860. doi: 10.1007/s11845-022-03208-2. Epub 2022 Nov 7.
Trauma is one of the common reasons for emergency department (ED) presentations. Specifically, severe-trauma patients often present with mortal complications, including traumatic shock or respiratory or multiorgan failure/dysfunction, and these situations cause high-mortality risk. Scoring systems in the triage of trauma patients can help determine the injury's severity and the patient's prognosis.
In this study, we aimed to compare Early-Warning Score (EWS), Revised Trauma Score (RTS), and CRAMS to predict the severity and prognosis of damage among high-energy-trauma patients.
This retrospective study included adult high-energy-trauma patients (> 18 years of age) assessed in our emergency department (ED) from April 1, 2020, to September 31, 2020. We included a total of 177 high-energy-trauma patients in the study. We compared the effectiveness of EWS; RTS; and circulation, respiration, abdomen, motor, and speech (CRAMS) in predicting mortality. The primary outcome of this study was mortality.
We included 67 females and 110 males with a mean age of 39.2 in our study. Of those patients, 6 died during ICU hospitalization and 104 were discharged from the ward. RTS (AUC: 0.978, CI: 0.945-0.994, p < 0.001) and CRAMS (AUC: 0.978, CI: 0.944-0.994, p < 0.001) had the same AUC values, but the AUC value of EWS (AUC: 0.966, CI: 0.927-0.987, p < 0.001) was lower. Sensitivity of EWS was 93.1 (CI: 77.2-99.2%), and sensitivity of RTS was 96.55 (CI: 82.2-99.9) and CRAMS' sensivity was 96.55% (CI: 82.2-99.9). RTS showed the highest specivity level (96.62%, CI: 92.3-98.9).
In conclusion, RTS and CRAMS better predicted mortality in high-energy-trauma patients than EWS.
创伤是急诊科（ED）就诊的常见原因之一。具体来说，严重创伤患者常出现致命并发症，包括创伤性休克或呼吸或多器官衰竭/功能障碍，这些情况导致高死亡率风险。创伤患者分诊中的评分系统有助于确定损伤的严重程度和患者的预后。
本研究旨在比较早期预警评分（EWS）、修订创伤评分（RTS）和 CRAMS 对高能创伤患者损伤严重程度和预后的预测价值。
本回顾性研究纳入了 2020 年 4 月 1 日至 2020 年 9 月 31 日在我院急诊科评估的成人高能创伤患者（>18 岁）。共纳入 177 例高能创伤患者。我们比较了 EWS；RTS；循环、呼吸、腹部、运动和言语（CRAMS）在预测死亡率方面的有效性。本研究的主要结局是死亡率。
我们的研究纳入了 67 名女性和 110 名男性，平均年龄为 39.2 岁。其中 6 人在 ICU 住院期间死亡，104 人从病房出院。RTS（AUC：0.978，CI：0.945-0.994，p<0.001）和 CRAMS（AUC：0.978，CI：0.944-0.994，p<0.001）具有相同的 AUC 值，但 EWS 的 AUC 值（AUC：0.966，CI：0.927-0.987，p<0.001）较低。EWS 的灵敏度为 93.1%（CI：77.2-99.2%），RTS 的灵敏度为 96.55%（CI：82.2-99.9），CRAMS 的灵敏度为 96.55%（CI：82.2-99.9）。RTS 显示出最高的特异性水平（96.62%，CI：92.3-98.9）。
总之，RTS 和 CRAMS 比 EWS 更好地预测高能创伤患者的死亡率。
