Clin Exp Emerg Med.  2019 Jun;6(2):152-159. 10.15441/ceem.18.027.

New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study

Affiliations
  • 1Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ssberg@snu.ac.kr
  • 2Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
  • 3Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 4Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract


OBJECTIVE
Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.
METHODS
We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure < 90 mmHg, peripheral capillary oxygen saturation < 90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.
RESULTS
In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P < 0.01).
CONCLUSION
Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.

Keyword

Brain injuries, traumatic; Mortality; Disability; Quality improvement; Prehospital

MeSH Terms

Anoxia*
Area Under Curve
Blood Pressure
Brain Injuries*
Capillaries
Fires
Glasgow Coma Scale*
Glasgow Outcome Scale
Hospital Mortality
Humans
Hypotension*
Korea
Mortality*
Observational Study*
Oxygen
Quality Improvement
Respiratory Rate
Oxygen
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