Defilippi Dylan A, Salcido David D, Zikmund Chase W, Weiss Leonard S, Schoenling Andrew, Martin-Gill Christian, Guyette Francis X, Pinsky Michael R
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Emergency Medicine, UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania.
Prehosp Emerg Care. 2024 Nov 15:1-7. doi: 10.1080/10903127.2024.2425382.
The combination of broad conditional applicability and ease of data collection make some general risk scores an attractive tool for clinical decision making under acute care conditions. To date, general risk scores have demonstrated moderate levels of accuracy for key outcomes, but there are no definitive general scores integrated universally into prehospital care. The objective of our study was to demonstrate a relationship between the Revised Trauma Score (RTS) and prehospital lifesaving interventions (LSI) and downstream hospital mortality among a large, diverse, multi-year cohort of critical care transport patients. We hypothesized that the RTS is associated with mortality and prehospital LSI generally across all conditions, including non-trauma.
We conducted a retrospective observational study using a pre-established cohort of sequentially enrolled patients from a regional air medical service between the years 2012 and 2021. Pediatric patients, non-transports, and those transported to hospitals outside the regional health system were excluded from the study. Both trauma and non-trauma patients were included in this study. We performed logistic regressions to evaluate the association between RTS and the outcomes of LSI and hospital mortality, while controlling for age, sex, and medical category. Graphs were constructed to plot RTS against prehospital LSI and survival percentage.
Our final patient cohort was 62,424 patients. 58.4% of all patients required a prehospital LSI. Non-trauma cases made up 69.7% of the patient population. The Revised Trauma Score was inversely proportional with both prehospital LSI and mortality. The logistic regression model yielded an odds ratio (OR) of 0.55 (95% CI 0.54 - 0.56) for the association between RTS and death. Additionally, when the components of RTS were associated with mortality, they each showed a statistically significant OR. The Revised Trauma Score was also associated with prehospital LSI (OR 0.10; 95% CI 0.03 - 0.33).
In a large helicopter EMS cohort of both trauma and non-trauma patients, the RTS was inversely associated with prehospital LSI and hospital mortality. The generalized utility of RTS demonstrated in our study warrants further investigation of this measure as a broader triage tool.
广泛的条件适用性和数据收集的便利性相结合，使得一些通用风险评分成为急性护理条件下临床决策的有吸引力的工具。迄今为止，通用风险评分已显示出对关键结局的中等准确性水平，但尚无明确的通用评分被普遍纳入院前护理。我们研究的目的是在一个大型、多样化、多年的重症监护转运患者队列中，证明修订创伤评分（RTS）与院前救生干预（LSI）以及下游医院死亡率之间的关系。我们假设RTS与所有情况下的死亡率和院前LSI普遍相关，包括非创伤情况。
我们进行了一项回顾性观察研究，使用了一个预先建立的队列，该队列来自2012年至2021年期间一个地区空中医疗服务机构按顺序登记的患者。儿科患者、非转运患者以及转运到地区卫生系统以外医院的患者被排除在研究之外。本研究纳入了创伤和非创伤患者。我们进行了逻辑回归分析，以评估RTS与LSI结局和医院死亡率之间的关联，同时控制年龄、性别和医疗类别。绘制图表以描绘RTS与院前LSI和生存率的关系。
我们的最终患者队列有62424名患者。所有患者中有58.4%需要院前LSI。非创伤病例占患者总数的69.7%。修订创伤评分与院前LSI和死亡率均呈反比。逻辑回归模型得出RTS与死亡之间关联的比值比（OR）为0.55（95%可信区间0.54 - 0.56）。此外，当RTS的各个组成部分与死亡率相关时，它们各自都显示出具有统计学意义的OR。修订创伤评分也与院前LSI相关（OR 0.10；95%可信区间0.03 - 0.33）。
在一个包括创伤和非创伤患者的大型直升机紧急医疗服务队列中，RTS与院前LSI和医院死亡率呈负相关。我们研究中证明的RTS的广泛实用性值得进一步研究将该指标作为更广泛的分诊工具。
