Optimal Prospective Predictors of Mortality in Austere Environments

Area of Science:

• Trauma research
• Emergency medicine
• Critical care

Background:

• Prospective predictors for trauma outcomes are crucial for management, especially in low-resource settings.
• Validating these predictors is essential for guiding clinical decisions in combat and humanitarian scenarios.

Purpose of the Study:

• To identify the optimal prospective prediction method for mortality in combat and humanitarian trauma.
• To compare the predictive accuracy of various scoring systems at different time points.

Main Methods:

• Retrospective review of the Department of Defense Trauma Registry (2008-2016).
• Calculation of Areas Under Receiver Operating Characteristic Curves (AUROCs) for Shock Index (SI), reverse SI × Glasgow Coma Scale (rSIG), SI × Glasgow Coma Scale (SIG), Revised Trauma Score, and Trauma and Injury Severity Score (TRISS).
• Assessment of predictability on mortality at point of injury and emergency department (ED) arrival.

Main Results:

• A total of 22,218 patients were analyzed, with 3.4% mortality, predominantly penetrating injuries.
• Emergency department vitals showed higher mortality predictability than point-of-injury vitals for all assessed tools.
• TRISS (AUROC 0.955) and rSIG (AUROC 0.923) demonstrated the highest predictability; rSIG cutoff of 14.1 showed 89% sensitivity and 87% specificity.

Conclusions:

• Initial ED vital signs are superior predictors of early mortality compared to point-of-injury vitals.
• TRISS and rSIG are the most predictive tools for mortality.
• rSIG is proposed as the optimal prospective scoring tool due to its ease of calculation and high predictive accuracy for mortality.