Sequential trauma indexing as universal tool for outcome prediction in patients with multiple injuries

Abstract

Background

Currently used scoring systems require complex calculation and training so it is not routinely used like GCS despite increase in trauma cases. All the scoring systems evaluate patients once initially without considering role of resuscitation. So, we propose a sequential scoring system for all levels of trauma to predict the survival outcome related to the initial injury severity and the treatment response in first 24 h of trauma by simple summation of routinely used data.

Methods

The study was conducted on 377 patients with acute trauma using only routinely used clinical and laboratory investigations. A total of 10 parameters were used with predetermined score allotted for each condition. The maximum possible score was 25 and minimum of 06. Low score indicated poor outcome.

Results

Based on the clinical interpretation of the data and actual clinical outcome three zone of has been designated -

• 1.
  Red Zone (Score 9–15) – Serious threat to survival.
• 2.
  Yellow Zone (Score 16–20) – Probable threat to survival.
• 3.
  Green Zone (Score 21–25) – Minimal or no threat to survival

The 24-h total score was the most important predictor according to the ROC curve (AUC 0.944, p: <0.0001) followed by the 6-h total score (AUC 0.904, p: <0.0001) and the one-time total score (AUC: 0.713, p: <0.0001).

Conclusion

The sequential summation of routine investigation done for multiple injured patients can give a unique tool like GCS which is universal to use and can also predict outcome. The indexing tool developed in the current study was able to predict mortality of patients with multiple injuries within 24 h following admission.