Simplifying physiologic injury severity measurement for predicting trauma outcomes.
BACKGROUND
The Revised Trauma Score (RTS) is commonly used to assess physiologic injury; however its use is limited by missing data. This study compares different parameters of physiologic injury assessment in their ability to predict mortality after trauma.


METHODS
Adult patients in the National Trauma Data Bank (NTDB version 7.0) were analyzed, and the following physiologic injury parameters were compared: RTS, systolic blood pressure (SBP), shock (SBP <or= 90 mm Hg), Glasgow coma scale-total (GCS-T), and GCS-motor (GCS-M). Areas under the receiver-operating characteristic curves (AUROC) were calculated for unadjusted and multivariate regression models to predict mortality after trauma.


RESULTS
There were 1,484,648 patients who met inclusion criteria. In unadjusted analyses, RTS had the highest proportion of missing data (21%) and was highly predictive of mortality (AUROC = 0.85). SBP and shock had a much lower AUROC of 0.67 and 0.66, respectively, but had many fewer missing cases. The combination parameters of GCS-M with SBP or GCS-M with shock showed AUROC comparable to RTS (0.85) with approximately 80,000 fewer missing cases.


CONCLUSIONS
The discriminatory power of RTS is significantly better than SBP, shock, or GCS alone. Given the limitation of missing data associated with RTS, the combination of SBP and GCS-M is a more reliable and equally effective method of assessing physiologic injury severity in studying trauma outcomes.
Oyetunji
Tolulope
T
Department of Surgery, Howard University College of Medicine, Washington, D.C.
Crompton
Joseph G
JG
Efron
David T
DT
Haut
Elliott R
ER
Chang
David C
DC
Cornwell
Edward E
EE
Baker
Susan P
SP
Haider
Adil H
AH
D000328:Adult; D015600:Glasgow Coma Scale; D006801:Humans; D009043:Motor Activity; D018579:Patient Selection; D015203:Reproducibility of Results; D013599:Systole; D015599:Trauma Severity Indices; D014194:Traumatology / Q000379:methods*; D016896:Treatment Outcome