[Is the Mainz Emergency Evaluation Scoring system (MEES) in combination with capnometry (MEESc) useful in prehospital prediction of outcome in trauma with ISS > 14?].
BACKGROUND
This prospective study assessed the efficacy of the predicting power for mortality of two different prehospital scoring systems in trauma with ISS > 14. We present an improved Mainz Emergency Evaluation Scoring system (MEES) in combination with capnometry (MEESc). MEESc is a new scoring system.


METHODS
In a prehospital setting, the values of MEES and capnometry (initial and final) were collected from each patient. We added final values of partial pressure of end-tidal CO2 (petCO2) to the MEES scoring system and ranked them from 0 to 2 so that the final maximum sum of this scoring system would be 30 without any change in the minimal score being 10. This study was performed over 4 years (from January 2000 to December 2004) and included 114 consecutive patients hospitalized for major trauma with ISS >14, requiring intubation at the roadside and in whom prehospital petCO2 had been recorded. Patients younger than 16 years and those with severe hypothermia (core temperature less than 30 degrees C) were excluded from the study. There were 81 males and 34 females, age range 16 to 82, mean 41.8 +/- 16.4 years. For every scoring system, the sensitivity, specificity, correct outcome prediction and area under the ROC curve were determined. Results were compared with McNemar's test in Z score. A significant difference was p < 0.05.


RESULTS
For prediction of mortality, the best cutoff points were 20 for MEES and 23 for MEESc. The area under the ROC curve was 0.63 for MEES and 0.81 for MEESc (p < 0.05).


CONCLUSIONS
There were significant differences between MEES and MEESc. MEESc improved the results of MEES in predicting trauma outcome with ISS > 14. The prehospital use of the improved MEESc system could be an efficient communication protocol between the prehospital and hospital settings.
Grmec
Stefek
S
Centar za hitnu medicinsku pomoć, Maribor, Maribor, Slovenija.
Spindler
Mateja
M
Hren
Tatjana
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019296:Capnography; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification* / Q000401:mortality; D011379:Prognosis; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices