Physiologic Scoring Systems versus Glasgow Coma Scale in Predicting In-Hospital Mortality of Trauma Patients; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
,
Page e64
https://doi.org/10.22037/aaem.v9i1.1376
Abstract
Introduction: In recent years, several scoring systems have been developed to assess the severity of trauma and predict the outcome of trauma patients. This study aimed to compare Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) in predicting the in-hospital mortality of trauma patients.
Methods: This diagnostic accuracy study was done on adult patients admitted to the emergency department (ED) between June 21, 2019, and September 21, 2020, following multiple trauma. Patients were followed as long as they were hospitalized. The REMS, MEWS, GCS, and ISS were calculated after data gathering and comprehensive assessment of injuries. Receiver operating characteristics (ROC) analysis was performed to examine the prognostic performance of the four different tools.
Results: Of the 754 patients, 32 patients (4.2%) died and 722 (95.8%) survived after 24 hours of admission. The mean age of the patients was 38.54 ± 18.58 years (78.9% male). The area under the ROC curves (AUC) of REMS, MEWS, ISS, and GCS score for predicting in-hospital mortality were 0.942 (95% CI [0.923-0.958]), 0.886 (95% CI [0.861-0.908]), 0.866 (95% CI [0.839-0.889]), and 0.851 (95% CI [0.823-0.876]), respectively. The AUC of REMS was significantly higher than GCS (p=0.035). The sensitivities of GCS ≤ 11, ISS ≥ 13, REMS ≥ 4, and MEWS ≥ 3 scores for in-hospital mortality were 0.56, 0.97, 0.81, and 0.94, respectively. Also, the specificities of GCS, ISS, REMS, and MEWS scores for in-hospital mortality were 0.93, 0.82, 0.81, and 0.85, respectively.
Conclusion: It seems that REMS is more accurate than GCS, ISS, and MEWS in predicting in-hospital mortality ≥ 24 hours of multiple trauma patients.
- Multiple trauma
- Injury severity score
- scoring system/ Clinical Decision Rules
- Emergency service, hospital
- Patient outcome assessment
- Prognosis
How to Cite
References
Heydari F, Maghami M-H, Esmailian M, Zamani M. The effect of implementation of the standard clinical practice guideline (CPG) for management of multiple trauma patients admitted to an emergency department. Advanced journal of emergency medicine. 2018;2(1):e5.
Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, et al. Increasing trauma deaths in the United States. Annals of surgery. 2014;260(1):13-21.
Miller RT, Nazir N, McDonald T, Cannon CM. The modified rapid emergency medicine score: a novel trauma triage tool to predict in-hospital mortality. Injury. 2017;48(9):1870-7.
Park HO, Kim JW, Kim SH, Moon SH, Byun JH, Kim KN, et al. Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: a retrospective cohort study. Medicine. 2017;96(44):e8449.
Gök RGY, Gök A, Bulut M. Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department. International emergency nursing. 2019;43:9-14.
Dur A, Cander B, Koçak S, Girişgin S, Gül M, Koyuncu F. Multiple trauma patients and trauma scoring systems in emergency-intensive care unit. JAEM. 2009;8(4):24-7.
Masoumi B, Heydari F, Hatamabadi H, Azizkhani R, Yoosefian Z, Zamani M. The relationship between risk factors of head trauma with CT scan findings in children with minor head trauma admitted to hospital. Open access Macedonian journal of medical sciences. 2017;5(3):319.
Olsson T, Terént A, Lind L. Rapid Emergency Medicine Score: a new prognostic tool for in‐hospital mortality in nonsurgical emergency department patients. Journal of internal medicine. 2004;255(5):579-87.
Bulut M, Cebicci H, Sigirli D, Sak A, Durmus O, Top AA, et al. The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department. Emergency Medicine Journal. 2014;31(6):476-81.
Imhoff BF, Thompson NJ, Hastings MA, Nazir N, Moncure M, Cannon CM. Rapid Emergency Medicine Score (REMS) in the trauma population: a retrospective study. BMJ open. 2014;4(5):e004738.
Yousefifard M, Shahsavarinia K, Faridaalee G, Dinpanah H, Ahmadi S, Safari S. Comparison of Glasgow Coma Scale with Physiologic Scoring Scales in Prediction of In-Hospital Outcome of Trauma Patients; a Diagnostic Accuracy Study. Advanced Journal of Emergency Medicine. 2020;4(4):e89.
Lecky F, Woodford M, Edwards A, Bouamra O, Coats T. Trauma scoring systems and databases. British Journal of Anaesthesia. 2014;113(2):286-94.
Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emergency Medicine Journal. 2006;23(5):372-5.
Nakhjavan-Shahraki B, Baikpour M, Yousefifard M, Nikseresht ZS, Abiri S, Razaz JM, et al. Rapid acute physiology score versus rapid emergency medicine score in Trauma Outcome Prediction; a comparative study. Emergency. 2017;5(1):e30.
Fullerton JN, Price CL, Silvey NE, Brace SJ, Perkins GD. Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation. 2012;83(5):557-62.
Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. Qjm. 2001;94(10):521-6.
Salottolo K, Carrick M, Johnson J, Gamber M, Bar-Or D. A retrospective cohort study of the utility of the modified early warning score for interfacility transfer of patients with traumatic injury. BMJ open. 2017;7(5):e016143.
Jiang X, Jiang P, Mao Y. Performance of Modified Early Warning Score (MEWS) and Circulation, Respiration, Abdomen, Motor, and Speech (CRAMS) score in trauma severity and in-hospital mortality prediction in multiple trauma patients: a comparison study. PeerJ. 2019;7:e7227.
- Abstract Viewed: 899 times
- pdf Downloaded: 398 times
