emergency trauma score as a predictor of mortality in clinical practice. a. fischinger, m....

Emergency Trauma Score as a predictor of mortality in clinical

practice.

A. Fischinger, M. Tomaževič, M. Cimerman, A. KristanDept. of Traumatology. University Medical Centre Ljubljana, Slovenia

Introduction

• Scoring systems are usually used for clinical research by dividing patients into comparable groups. The results from researches are used to evaluate and improve patient management, care and survival.

• Multiple trauma scores are used to assess injury severity sustained by a patient.

• Scoring systems can be used to predict outcome from trauma, but their use is limited and they are usually difficult to calculate in clinical practice.

Introduction

• Scoring systems are usually used for clinical research by dividing patients into comparable groups. The results from researches are used to evaluate and improve patient management, care and survival.

• Multiple trauma scores are used to asses injury severity sustained by a patient.

• Scoring systems can be used to predict outcome from trauma, but their use is limited and they are usually difficult to calculate in clinical practise.

• But this is nothing new…

“In acute diseases it is not quite safe to prognosticate either death or recovery”

Hippocrates (c.460 –c. 370 BC)

AIS

APACHEISS

AP

EMTRAS

SAPS

SIRSGSC

Raum MR, Nijsten MW, Vogelzang M, et al. Emergency trauma score: an instrument for early estimation of trauma severity. Crit Care Med. 2009;37(6):1972-7.

„Validation of the score, using a dataset containing 3314 severely injured patients showed it to outperform the RTS, ISS, NISS and TRISS“ (Nijboer, J.M.M. New insights in outcome after major trauma. Thesis, University of Groningen, the Netherlands 2009 ISBN: 978-90-367-4035-7)

Emergency Trauma Score (EMTRAS)

Comprises 4 parameters:• Glasgow Coma Scale (GCS) • Patient age• Base excess (BE)• Prothrombin time (PT).

Each parameter is subdivided into four classes, scored from 0 to 3 points. Scores of each class are summed to obtain

the EMTRAS, ranging from 0 to 12.

Raum MR, Nijsten MW, Vogelzang M, et.

Emergency trauma score (EMTRAS)

AGE GCS BE PT

0 40 15-13 >-1 <80%

1 40-60 12-10 -5 through -1 80% through 50%

2 61-75 9-6 -10 through -5.1 49% through 20%

3 75+ 3-5 <-10 >20%

A high EMTRAS, i.e. a score > 8 should alert the trauma team that the patient has a high mortality risk (Nijboer, J.M.M.)

Our study

• A retrospective analysis of all patients (334) who were admitted to the resuscitation bay during a period of one year (2012) at our trauma center was performed.

• The EMTRAS as well as ISS were calculated and compared to mortality of the patients

Our study

Out of 334 patients EMTRAS was not possible to calculate for 120 (36%) patients due to missing data.

Analysis

EMTRAS 0 1 2 3 4 5 6 7 8 9 10 11 12

ISS (average) 5.6 10.6 13.2 15.37 17.18 18.82 20.91 24.07 20.35 27 37 2 XNumber of patients (214) 5 10 24 32 43 29 24 13 20 12 1 1 0

Mortality 0 10 4,1 6,25 13,9 13,7 33,3 38,4 55 66,6 100 100 X

Analysis

Problems with the study

• No exclusion criteria• Out of 334 patients EMTRAS was not possible

to calculate for 120 (36%) patients due to missing data – which was usually the BE obtained by arterial blood gas analysis not usually done in example children with fewer cramps, hospital transfers, etc.

• Field GCS is elusive

Conclusion

• EMTRAS is practical and easy to calculate in clinical practice.

• EMTRAS is a good predictor of mortality.

• Further validation of the EMTRAS score is required.

• EMTRAS score of seven or more should alert the trauma team trating the patient.

• Decisions for individual patients should never be based solely on a statistically derived score.

Thank you