Nutbeam Tim, Stassen Willem, Foote Emily, Ageron Francois-Xavier
IMPACT: Centre for Post-Collision Research, Innovation and Translation, Exeter, UK
Emergency Department, Univeristy Hospitals Plymouth NHS Foundation Trust, Plymouth, UK.
BMJ Open. 2024 Dec 26;14(12):e090517. doi: 10.1136/bmjopen-2024-090517.
To develop and validate a simplified Bleeding Audit Triage Trauma (sBATT) score for use by lay persons, or in areas and environments where physiological monitoring equipment may be unavailable or inappropriate.
The sBATT was derived from the original BATT, which included prehospital systolic blood pressure (SBP), heart rate, respiratory rate, Glasgow Coma Scale (GCS), age and trauma mechanism. Variables suitable for lay interpretation without monitoring equipment were included (age, level of consciousness, absence of radial pulse, tachycardia and trapped status). The sBATT was validated using data from the UK Trauma Audit Research Network (TARN) registry.
Data sourced from prehospital observations from multiple trauma systems in the UK.
70 027 motor vehicle collision (MVC) patients from the TARN registry (2012-2019). Participants included were those involved in MVCs, with exclusion criteria being incomplete data or non-trauma-related admissions.
Not applicable.
Death within 24 hours of MVC. Secondary: need for trauma intervention.
In a cohort of 70 027 MVC patients, 1976 (3%) died within 24 hours. The sBATT showed an area under receiver operating characteristic curve of 0.90 (95% CI: 0.90 to 0.91) for predicting 24-hour mortality, surpassing other trauma scores such as the Shock Index and Assessment of Blood Consumption score. Sensitivity was 96% and specificity 72%, with a negative likelihood ratio below 0.1, indicating strong rule-out capability. Sensitivity analyses confirmed consistent performance across varying SBP and GCS thresholds. The sBATT was equally effective across sexes with no significant predictive discrepancies.
The sBATT is a novel, simplified tool that performs well at predicting early death in the TARN dataset. It demonstrates high predictive accuracy for 24-hour mortality and need for trauma intervention. Further research should validate sBATT in diverse populations and real-world scenarios to confirm its utility and applicability.
开发并验证一种简化的出血审计分诊创伤（sBATT）评分，供非专业人员使用，或在生理监测设备可能无法获取或不适用的区域和环境中使用。
sBATT源自原始的BATT，后者包括院前收缩压（SBP）、心率、呼吸频率、格拉斯哥昏迷量表（GCS）、年龄和创伤机制。纳入了适合非专业人员在无监测设备情况下解读的变量（年龄、意识水平、桡动脉搏动消失、心动过速和被困状态）。使用来自英国创伤审计研究网络（TARN）登记处的数据对sBATT进行验证。
数据源自英国多个创伤系统的院前观察。
来自TARN登记处（2012 - 2019年）的70027名机动车碰撞（MVC）患者。纳入的参与者为那些涉及机动车碰撞的患者，排除标准为数据不完整或非创伤相关入院。
不适用。
机动车碰撞后24小时内死亡。次要指标：创伤干预需求。
在70027名机动车碰撞患者队列中，1976名（3%）在24小时内死亡。sBATT在预测24小时死亡率方面的受试者操作特征曲线下面积为0.90（95%CI：0.90至0.91），超过了其他创伤评分，如休克指数和失血评估评分。敏感性为96%，特异性为72%，阴性似然比低于0.1，表明具有很强的排除能力。敏感性分析证实，在不同的SBP和GCS阈值下表现一致。sBATT在不同性别中同样有效，无显著的预测差异。
sBATT是一种新颖、简化的工具，在TARN数据集中预测早期死亡方面表现良好。它在预测24小时死亡率和创伤干预需求方面显示出高预测准确性。进一步的研究应在不同人群和现实场景中验证sBATT，以确认其效用和适用性。
