Dataset Information

Prehospital mSOFA Score for Quick Prediction of Life-Saving Interventions and Mortality in Trauma Patients: A Prospective, Multicenter, Ambulance-based, Cohort Study.

ABSTRACT: Background: Prehospital emergency medical services (EMS) are the main gateway for trauma patients. Recent advances in point-of-care testing and the development of early warning scores have allowed EMS to improve patient classification. We aimed to identify patients presenting with major trauma involving life-saving interventions (LSI) using the modified Sequential Organ Failure Assessment (mSOFA) score in the prehospital scenario, and to compare these results with those of other trauma scores. Methods: This was a prospective, ambulance-based, multicenter, training-validation study in trauma patients who were treated in a prehospital setting and subsequently transported to a hospital. The study involved six Advanced Life Support units, 38 Basic Life Support units, and four hospitals. The primary outcome was LSI performed at the scene or en route and intensive care unit (ICU) admission and all-cause two-day in-hospital mortality. We collected epidemiological variables, creatinine, lactate, base excess, international normalized ratio, and vital signs. Discriminative power (area under the receiver operating characteristic curve [AUC]), calibration (observed vs predicted outcome agreement), and decision-curve analysis (DCA, clinical utility) were used to assess the reliability of the mSOFA in comparison to other scores. Results: Between January 1, 2020-April 30, 2022, a total of 763 patients were selected. The mSOFA score's AUC was 0.927 (95% confidence interval [CI] 0.898-0.957) for LSI, 0.845 (95% CI 0.808-0.882) for ICU admission, and 0.979 (95% CI 0.966-0.991) for two-day mortality. Conclusion: The mSOFA score outperformed the other scores, allowing a quick identification of high-risk patients. The routine implementation in EMS of mSOFA could provide critical support in the decision-making process in time-dependent trauma injuries.

SUBMITTER: Martin-Rodriguez F

PROVIDER: S-EPMC10527847 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Prehospital mSOFA Score for Quick Prediction of Life-Saving Interventions and Mortality in Trauma Patients: A Prospective, Multicenter, Ambulance-based, Cohort Study.

Martín-Rodríguez Francisco F Sanz-García Ancor A Justel Ana Benito AB Sánchez Almudena Morales AM Oleaga Cristina Mazas Perez CMP Delgado Noya Irene I Soberón Irene Sánchez IS Del Pozo Vegas Carlos C Benito Juan F Delgado JFD López-Izquierdo Raúl R

The western journal of emergency medicine 20230901 5

<b>Background:</b> Prehospital emergency medical services (EMS) are the main gateway for trauma patients. Recent advances in point-of-care testing and the development of early warning scores have allowed EMS to improve patient classification. We aimed to identify patients presenting with major trauma involving life-saving interventions (LSI) using the modified Sequential Organ Failure Assessment (mSOFA) score in the prehospital scenario, and to compare these results with those of other trauma sc ...[more]

PMID: 37788027

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Project description:IntroductionSeveral prehospital trauma triage tools have been recently developed, but no standardized tools currently exist to identify trauma patients at risk of requiring resuscitative interventions (RIs) within the first 24 h post-injury and to prioritize their transport to high-level trauma facilities.MethodsThis prognostic study employed a retrospective cohort design to evaluate the predictive performance of the Triage Revised Score (T-RTS), Glasgow Coma Scale, Age, and Systolic Blood Pressure Score (GAP), Mechanism, Glasgow Coma Scale, Age, and Systolic Blood Pressure Score (MGAP), National Early Warning Score 2 (NEWS-2), Shock Index (SI), and Reverse Shock Index multiplied by Glasgow Coma Scale (rSIG) in predicting the need for RIs within 24 h. Data was retrieved from the electronic medical records of Ramathibodi Hospital, and the study included patients aged ≥ 15 years who were categorized as high-risk or life-threatening and subsequently transported to the emergency department. We used Area Under the Receiver Operating Characteristic (AUROC) curve and calibration plots to assess the performance of prehospital trauma triage tools.ResultsThere were 440 traumatic injury patients enrolled in the study, with 44 (10%) receiving RIs. T-RTS, GAP, MGAP, and NEWS-2 demonstrate good discriminative and predictive performance for RIs within 24 h after an injury (AUROC of 0.969, 0.949, 0.971, and 0.929, respectively, with the O:E ratio of 1). With the predefined standard cut-off values, the GAP score of less than 19 results in the highest accuracy for ruling out patients who do not need RIs (Specificity = 94.4% and NPV = 94.1%, p-value < 0.001).ConclusionsSeveral commonly used prehospital trauma triage tools demonstrate good predictive abilities for identifying the need for RIs. Among these, the GAP score with a threshold value of 19 serves as an optimal tool for identifying patients who require transfer to high-level trauma facilities.

Project description:BackgroundMyocardial infarction (MI) patients presenting without chest pain are a diagnostic challenge. They receive suboptimal prehospital management and have high mortality. To elucidate potential benefits of improved management, we analysed expected outcome among non-chest pain MI patients if hypothetically they (1) received emergency ambulances/acetylsalicylic acid (ASA) as often as observed for chest pain patients, and (2) all received emergency ambulance/ASA.MethodsWe sampled calls to emergency and non-emergency medical services for patients hospitalized with MI within 24 h and categorized calls as chest pain/non-chest pain. Outcomes were 30-day mortality and a 1-year combined outcome of re-infarction, heart failure admission, and mortality. Targeted minimum loss-based estimation was used for all statistical analyses.ResultsAmong 5418 calls regarding MI patients, 24% (1309) were recorded with non-chest pain. In total, 90% (3689/4109) of chest pain and 40% (525/1309) of non-chest pain patients received an emergency ambulance, and 73% (2668/3632) and 37% (192/518) of chest pain and non-chest pain patients received prehospital ASA. Providing ambulances to all non-chest pain patients was not associated with improved survival. Prehospital administration of ASA to all emergency ambulance transports of non-chest pain MI patients was expected to reduce 30-day mortality by 5.3% (CI 95%: [1.7%;9%]) from 12.8% to 7.4%. No significant reduction was found for the 1-year combined outcome (2.6% CI 95% [- 2.9%;8.1%]). In comparison, the observed 30-day mortality was 3% among ambulance-transported chest pain MI patients.ConclusionsOur study found large differences in the prehospital management of MI patients with and without chest pain. Improved prehospital ASA administration to non-chest pain MI patients could possibly reduce 30-day mortality, but long-term effects appear limited. Non-chest pain MI patients are difficult to identify prehospital and possible unintended effects of ASA might outweigh the potential benefits of improving the prehospital management. Future research should investigate ways to improve the prehospital recognition of MI in the absence of chest pain.

Dataset Information

Prehospital mSOFA Score for Quick Prediction of Life-Saving Interventions and Mortality in Trauma Patients: A Prospective, Multicenter, Ambulance-based, Cohort Study.

Publications

Prehospital mSOFA Score for Quick Prediction of Life-Saving Interventions and Mortality in Trauma Patients: A Prospective, Multicenter, Ambulance-based, Cohort Study.

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