title: Triage Revised Trauma Score change between first assessment and arrival at the hospital to predict mortality.
abstract: OBJECTIVE
  To assess among seriously injured accident victims whether change of the Triage Revised Trauma Score (T-RTS) between first assessment and arrival at the hospital independently predicts mortality.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The study analysed data on 507 trauma patients with multiple injuries and with a Hospital Trauma Index-Injury Severity Score (HTI-ISS) of 16 or higher, who were presented directly by ambulance services to the Accident & Emergency Department of the University Medical Centre Utrecht (the Netherlands) in 1999 and 2000.
  
  
  RESULTS
  Compared to non-intubated patients whose T-RTS remained unchanged (reference category), the mortality risk was 3.1 times higher [95% confidence interval (CI): 1.5-6.3, p = 0.001] for patients with deteriorating T-RTS, 2.9 times higher (95% CI: 1.3-6.5, p < 0.001) for patients who had an initially good T-RTS but were nevertheless intubated and 5.7 times higher (95% CI: 3.6-9.0, p < 0.001) for patients who had an initially poor T-RTS and were intubated. These associations were independent of factors that could be assumed to have a direct effect on T-RTS, that is intravenous therapy, oxygen administration and being attended to by a mobile medical team at the scene of the accident. Along with T-RTS change, more advanced age was associated with a higher mortality risk.
  
  
  CONCLUSIONS
  Intubation and a deteriorating T-RTS between the time of the accident and patient's arrival at the hospital are powerful independent predictors of mortality after hospitalisation. Together with advanced age, a deteriorating T-RTS should be the main aspect guiding the preclinical procedures.
authors.affiliation: Department of Ophthalmology, Stichting Regionale Ambulance Voorziening Provincie Utrecht, Bilthoven, Netherlands. r.lichtveld@ravu.nl
authors.forename: R A
authors.initials: RA
authors.lastname: Lichtveld
authors.forename: A T E
authors.initials: AT
authors.lastname: Spijkers
authors.forename: J M
authors.initials: JM
authors.lastname: Hoogendoorn
authors.forename: I F
authors.initials: IF
authors.lastname: Panhuizen
authors.forename: Chr
authors.initials: C
authors.lastname: van der Werken