title: Development of a scoring system based on conventional parameters to assess polytrauma patients: PolyTrauma Grading Score (PTGS).
abstract: BACKGROUND
  The impact of conventional laboratory data to identify polytrauma patients at risk of complications is established. However, it has not been assessed in terms of prognostic accuracy for systemic complications (ARDS, organ failure). We therefore assessed the most predictive parameters for systemic complications and developed a scoring system for early grading of polytrauma patients.
  
  
  METHODS
  A population based trauma registry was used.
  
  
  METHODS
  age >16 years, Abbreviated Injury Score (AIS) of the abdomen or chest ≥ 3 points and treatment in an intensive care unit, or Injury Severity Score (ISS) ≥ 16 points. The primary endpoint was hospital mortality. Patients were graded according their risk of death: low risk of death (5-14% mortality), intermediate risk patients (15-39% mortality) and high risk (>40%). Routine clinical and laboratory parameters on admission were assessed to determine their specific relevance to describe the risk profile of the patient. Based on these data, a scoring system for the description of the clinical status was developed. Statistical analysis included uniand multivariate analysis.
  
  
  RESULTS
  11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73% were male, and 95.6% had blunt injuries. The most sensitive parameters were found to be the following ones: systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered. The multivariate analysis revealed the following threshold levels: BP 76-90 mmHg: r = 0.249, OR 1.283: Base deficit 8-10 r = 0.474, OR 1.606; INR 1.4-2 r = 0.160, OR 1.174; NISS 35-39 r = 0.9, OR 2.46; pBRC 3-14: r = 0.671, OR 1.957. The following ranges of score values were found to be associated with different patient status: <6 points: stable patients; 6-11 points: borderline condition; >11 points: unstable patients. When using this score, 80.6% were stable, 14.6% in a borderline condition and 4.8% unstable.
  
  
  CONCLUSIONS
  We developed a scoring system to discriminate polytrauma patients on admission that are at risk of systemic complications. Systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered are able to provide a prognosis of patients at risk of posttraumatic complications. Further prospective studies should be performed to verify this new scoring system.
authors.affiliation: Department of Orthopaedic Trauma at Aachen University, NRW, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Cologne, NRW, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Orthopaedic Trauma at Aachen University, NRW, Germany; Harald Tscherne Research Laboratory for Orthopaedic Trauma at Aachen, NRW, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Andruszkow
authors.affiliation: The University of Texas Health Science Center at San Antonio, TX USA.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Zelle
authors.affiliation: Department of Trauma and Orthopaedics, Royal Bolton Foundation NHS Trust, UK.
authors.forename: Bilal M
authors.initials: BM
authors.lastname: Barkatali
authors.affiliation: Department of Orthopaedic Trauma at Aachen University, NRW, Germany. Electronic address: papehc@aol.com.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
mesh_terms: D020000:Decision Support Systems, Clinical; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000401:mortality; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment
keywords: Polytrauma patients; borderline condition; clinical assessment; mortality; posttraumatic complications