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Prediction of Trauma Mortality Incorporating Pre-injury Comorbidities Into Existing Mortality Scoring Indices
Nasim Ahmed1,2, Yen-Hong Kuo2,3
1Division of Trauma and Surgical Critical Care, 23498Jersey Shore University Medical Center, Neptune, NJ, USA.
Insights
A new trauma mortality scoring system (TMS) accurately predicts in-hospital mortality in trauma patients. This novel scoring system outperforms existing trauma injury severity score (TRISS) and A Severity Characterization of Trauma (ASCOT) scores.
Area of Science:
- Trauma care research
- Medical predictive modeling
- Public health surveillance
Background:
- Trauma patient outcomes are critical in emergency medicine.
- Existing scoring systems like TRISS and ASCOT have limitations in predicting mortality.
- Accurate mortality prediction aids in resource allocation and treatment strategies.
Purpose of the Study:
- To develop a comprehensive trauma mortality scoring system (TMS).
- To evaluate TMS's ability to predict in-hospital mortality in trauma patients.
- To compare the predictive performance of TMS against TRISS and ASCOT.
Main Methods:
- Utilized the National Trauma Quality Improvement Program (TQIP) database (2011-2016).
- Included hospitalized trauma patients aged 16-89 years.
- Assessed predictive accuracy using receiver operating characteristic (ROC) curves and area under the curve (AUC).
Main Results:
- TMS demonstrated superior predictive performance in blunt trauma (AUC: 0.892) compared to TRISS (0.864) and ASCOT (0.841).
- TMS also showed better prediction for penetrating trauma (AUC: 0.949) versus TRISS (0.942) and ASCOT (0.924).
- Statistical significance (P < 0.0001 for blunt, P = 0.030 for penetrating) confirmed TMS superiority.
Conclusions:
- The developed trauma mortality scoring system (TMS) effectively predicts in-hospital mortality.
- TMS offers improved accuracy over TRISS and ASCOT for both blunt and penetrating trauma.
- This enhanced predictive capability can refine trauma patient management.
Objectives:
The purpose of the study is to develop a comprehensive risk score of mortality in trauma victims that can predict the in-hospital mortality better than trauma injury severity score (TRISS) and A Severity Characterization of Trauma (ASCOT) score.
Methods:
All hospitalized trauma patients, between the ages of 16 and 89 years old were included in the study. The National Trauma Quality Improvement Program (TQIP) database of the calendar year 2011-2016 was accessed for the development of a traum mortality scoring system (TMS). The prediction of mortality was tested by creating a receiver operating characteristics (ROC) curve and an area under the curve (AUC). ROCs and AUCs of TMS were compared with TRISS and ASCOT score.
Results:
The AUC of TMS (0.892, 95% CI: 0.888-0.896) was better than TRISS (0.864, 95% CI: 0.859-0.869, P <0.0001) and ASCOT (0.841, 95% CI: 0.835-0.846, P <0.0001), respectively, in blunt injury. Similarly, TMS prediction (AUC: 0.949, 95% CI: 0.940-0.958) was better in penetrating injury when compared with TRISS (0.942, 95% CI: 0.934-0.951, P = 0.030) and ASCOT (0.924, 95% CI: 0.912-0.936, P <0.0001), respectively.
Conclusion:
TMS can predict the in-hospital mortality better than TRISS and ASCOT.
