[Trauma scores in the management of politrauma patients: which one and what for?].
BACKGROUND
The improvement rescue and transport of politrauma patients (PTP) increases the number of patients admitted to the Emergency departments in very severe conditions. The early prediction of later complications and bad outcomes is paramount for a good strategy. The aim of this study was to evaluate the severity of PTP in the Trauma Room (TR) of a Level 1 Hospital, using the ISS, RTS, TRISS scores and define variables associated with bad outcomes, namely ICU admission (ICU), ARDS, MODS and Death.


METHODS
Prospective study with data collection of demographic, clinical, laboratory and imaging parameters of all PTP admitted to the TR. The ISS was calculated by the Abbreviated Injury Scale, RTS and TRISS by Trauma.org site formulas. Statistical analysis was performed in SPSS.


RESULTS
278 patients were admitted in TR after Manchester screening during 6 months: 244 (185 men, 59 women) were studied, average age 39,32±19.32 years. Hospital admission- 157 patients (ICU-46, Intermediate Care Unit-29, Surgery Services-82) and 85 discharged. Submitted to Surgery-75. Scores: ISS-13,58±19,32, RTS-7,30±1,01; TRISS-92,42±15,85; Glasgow Coma Score (GCS)-13,00±3,61.Severe complications: ARDS-8%; SIRS-40%; MODS-18%; Death-14%.


CONCLUSIONS
There is statistical correlation between Surgery Type: ICU and MODS; GCS, ISS, RTS, TRISS: ICU, ARDS, MODS and Death. Multivariate analysis shows that Surgery Type, GCS and TRISS predict ICU admission (ROC-0,884); TRISS predicts ARDS (ROC-0,844); TRISS predicts MODS (ROC-0,876); TRISS and age predicts Death (ROC-0,887).


CONCLUSIONS
This study confirms scores validity in PTP assessment, as they are able to predict severe complications. TRISS seems to be the best score for prediction of bad outcomes.
Serviço de Urgência, Hospital São João, Porto, Portugal.
António Nogueira
AN
Sousa
José A
JA
Paiva
Sara A
SA
Fonseca
Frederico J
FJ
Raposo
Alvaro M
AM
Loureiro
Luís F
LF
Valente
António M
AM
Gonçalves
Abel T
AT
Cabral
Luís
L
Almeida
D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D009104:Multiple Trauma / Q000150:complications*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology