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      Spanish vs USA cohort comparison of prehospital trauma scores to predict short-term mortality

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          Abstract

          Background

          This study aimed to evaluate three prehospital early warning scores (EWSs): RTS, MGAP and MREMS, to predict short-term mortality in acute life-threatening trauma and injury/illness by comparing United States (US) and Spanish cohorts.

          Methods

          A total of 8,854 patients, 8,598/256 survivors/nonsurvivors, comprised the unified cohort. Datasets were randomly divided into training and test sets. Training sets were used to analyse the discriminative power of the scores in terms of the area under the curve (AUC), and the score performance was assessed in the test set in terms of sensitivity (SE), specificity (SP), accuracy (ACC) and balanced accuracy (BAC).

          Results

          The three scores showed great discriminative power with AUCs>0.90, and no significant differences between cohorts were found. In the test set, RTS/MREMS/MGAP showed SE/SP/ACC/BAC values of 86.0/89.9/89.6/87.1%, 91.0/86.9/87.5/88.5%, and 87.7/82.9/83.4/85.2%, respectively.

          Conclusions

          All EWSs showed excellent ability to predict the risk of short-term mortality, independent of the country.

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          Most cited references27

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          Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement.

          Gary S. Collins, Johannes Reitsma, Douglas G. Altman … (2015)
          Prediction models are developed to aid health care providers in estimating the probability or risk that a specific disease or condition is present (diagnostic models) or that a specific event will occur in the future (prognostic models), to inform their decision making. However, the overwhelming evidence shows that the quality of reporting of prediction model studies is poor. Only with full and clear reporting of information on all aspects of a prediction model can risk of bias and potential usefulness of prediction models be adequately assessed. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Initiative developed a set of recommendations for the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. This article describes how the TRIPOD Statement was developed. An extensive list of items based on a review of the literature was created, which was reduced after a Web-based survey and revised during a 3-day meeting in June 2011 with methodologists, health care professionals, and journal editors. The list was refined during several meetings of the steering group and in e-mail discussions with the wider group of TRIPOD contributors. The resulting TRIPOD Statement is a checklist of 22 items, deemed essential for transparent reporting of a prediction model study. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. The TRIPOD Statement is best used in conjunction with the TRIPOD explanation and elaboration document. To aid the editorial process and readers of prediction model studies, it is recommended that authors include a completed checklist in their submission (also available at www.tripod-statement.org).
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            Assessment of coma and impaired consciousness. A practical scale.

            G Teasdale, B Jennett (1974)
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              A revision of the Trauma Score.

              W Copes, Donald S Gann, T Gennarelli … (1989)
              The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which were difficult to assess in the field. Two versions of the revised score have been developed, one for triage (T-RTS) and another for use in outcome evaluations and to control for injury severity (RTS). T-RTS, the sum of coded values of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity when compared with a triage criterion based on TS and GCS values. T-RTS correctly identified more than 97% of nonsurvivors as requiring trauma center care. The T-RTS triage criterion does not require summing of the coded values and is more easily implemented than the TS criterion. RTS is a weighted sum of coded variable values. The RTS demonstrated substantially improved reliability in outcome predictions compared to the TS. The RTS also yielded more accurate outcome predictions for patients with serious head injuries than the TS.
              Article 0 comments Cited 145 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ancor Sanz-García
                Journal
                Journal ID (nlm-ta): Clin Med (Lond)
                Journal ID (iso-abbrev): Clin Med (Lond)
                Title: Clinical Medicine
                Publisher: Royal College of Physicians
                ISSN (Print): 1470-2118
                ISSN (Electronic): 1473-4893
                Publication date PMC-release: 21 April 2024
                Publication date Collection: May 2024
                Publication date (Electronic): 21 April 2024
                Volume: 24
                Issue: 3
                Electronic Location Identifier: 100208
                Affiliations
                [a ]Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
                [b ]Biomedical Engineering and Telemedicine Centre, ETSI de Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
                [c ]Department of Applied Mathematics, University of the Basque Country (UPV/EHU), Bilbao, Spain
                [d ]Faculty of Health Sciences, University of Castilla – La Mancha (UCLM), Talavera, Spain
                [e ]Faculty of Medicine, University of Valladolid, Valladolid, Spain
                [f ]CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
                [g ]Emergency Department. Hospital Universitario Rio Hortega. Valladolid, Spain
                [h ]Emergency Department. Hospital Clínico Universitario. Valladolid, Spain
                [i ]Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
                Author notes
                [* ]Corresponding author at: Faculty of Health Sciences, Universidad de Castilla la Mancha. Avda. Real Fábrica de Seda, s/n 45600 Talavera de la Reina, Toledo, Spain. ancor.sanz@ 123456gmail.com
                [1]

                Joint first authors.

                Article
                Publisher Item ID: S1470-2118(24)05393-4 Publisher ID: 100208
                DOI: 10.1016/j.clinme.2024.100208
                PMC ID: 11101846
                PubMed ID: 38643832
                SO-VID: 781c4cc1-5a0b-4c7b-83c3-7cd510c342d1
                Copyright © © 2024 The Author(s)
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 3 November 2023
                Date accepted : 7 April 2024
                Categories
                Subject: Research Article

                Keywords: prehospital,trauma,early warning scores,short-term mortality
                Data availability:
                Keywords: prehospital, trauma, early warning scores, short-term mortality

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