UC Irvine Medical Center, Orange, CA, USA.
University of Southern California, Los Angeles, CA, USA.
Am Surg. 2024 Oct;90(10):2463-2470. doi: 10.1177/00031348241248784. Epub 2024 Apr 19.
Many current trauma mortality prediction tools are either too intricate or rely on data not readily available during a trauma patient's initial evaluation. Moreover, none are tailored to those necessitating urgent or emergent surgery. Our objective was to design a practical, user-friendly scoring tool using immediately available variables, and then compare its efficacy to the widely-known Revised Trauma Score (RTS). The adult 2017-2021 Trauma Quality Improvement Program (TQIP) database was queried to identify patients ≥18 years old undergoing any urgent/emergent operation (direct from Emergency Department to operating room). Patients were divided into derivation and validation groups. A three-step methodology was used. First, multiple logistic regression models were created to determine risk of death using only variables available upon arrival. Second, the weighted average and relative impact of each independent predictor was used to derive an easily calculated Immediate Operative Trauma Assessment Score (IOTAS). We then validated IOTAS using AUROC and compared it to RTS. From 249 208 patients in the derivation-set, 14 635 (5.9%) died. Age ≥65, Glasgow Coma Scale score <9, hypotension (SBP <90 mmHg), and tachycardia (>120/min) on arrival were identified as independent predictors for mortality. Using these, the IOTAS was structured, offering scores between 0-8. The AUROC for this was .88. A clear escalation in mortality was observed across scores: from 4.4% at score 1 to 60.5% at score 8. For the validation set (250 182 patients; mortality rate 5.8%), the AUROC remained consistent at .87, surpassing RTS's AUROC of .83. IOTAS is a novel, accurate, and now validated tool that is intuitive and efficient in predicting mortality for trauma patients requiring urgent or emergent surgeries. It outperforms RTS, and thereby may help guide clinicians when determining the best course of action in patient management as well as counseling patients and their families.
许多现有的创伤死亡率预测工具要么过于复杂，要么依赖于创伤患者初始评估期间不易获得的数据。此外，没有一个工具是专门为那些需要紧急或紧急手术的患者设计的。我们的目标是设计一个实用的、易于使用的评分工具，使用立即可用的变量，然后将其功效与广为人知的修订创伤评分（RTS）进行比较。
2017-2021 年创伤质量改进计划（TQIP）数据库被查询，以确定年龄≥18 岁的接受任何紧急/紧急手术（直接从急诊室到手术室）的患者。患者被分为推导组和验证组。使用了三步方法。首先，使用仅在到达时可用的变量创建多个逻辑回归模型来确定死亡风险。其次，使用每个独立预测因子的加权平均值和相对影响来推导出一个易于计算的即时手术创伤评估评分（IOTAS）。然后使用 AUROC 验证 IOTAS，并将其与 RTS 进行比较。
在推导组的 249208 名患者中，有 14635 名（5.9%）死亡。年龄≥65 岁、格拉斯哥昏迷评分<9 分、低血压（SBP<90mmHg）和到达时心动过速（>120/min）被确定为死亡的独立预测因子。使用这些因素，构建了 IOTAS，其评分范围为 0-8。AUROC 为 0.88。随着分数的增加，死亡率明显升高：从分数 1 的 4.4%到分数 8 的 60.5%。对于验证组（250182 名患者；死亡率为 5.8%），AUROC 保持在 0.87，超过了 RTS 的 0.83。
IOTAS 是一种新颖、准确的工具，现在已经验证，它直观且高效，可用于预测需要紧急或紧急手术的创伤患者的死亡率。它优于 RTS，因此可以帮助指导临床医生在确定患者管理的最佳行动方案以及咨询患者及其家属时提供帮助。
