Abstract
Objective
To determine which factors predict death among trauma patients who are alive on arrival
at hospital.
Methods
Design prospective cohort study method. Data were collected on 378 trauma patients
who were initially delivered by the emergency medical services of Navarre (Spain)
with multiple injuries with a new injury severity score of 15 or more in 2011–2012.
These data related to age, gender, presence of premorbid conditions, abbreviated injury
score, injury severity score, new injury severity score (NISS), revised trauma score
(RTS), and prehospital and hospital response times. Bivariate analysis was used to
show the association between each variable and time until death. Mortality prediction
was modeled using logistic regression analysis.
Results
The variables related to the end result were the age of the patient, associated comorbidity,
NISS, and hospital RTS. Two models were formulated: in one, the variables used were
quantitative, while in the other model these variables were converted into dichotomous
qualitative variables. The predictive capability of the two models was compared with
the trauma and injury severity score using the area under the curve. The predictive
capacities of the three models had areas under the curve of 0.93, 0.88, and 0.87.
The response times of the Navarre emergency services system, measured as the sum of
the time taken to reach the hospital (median time of 65 min), formulate computed tomography
(46 min), and perform crucial surgery (115 min), when required, were not taken into
account.
Conclusion
Age, premorbid conditions, hospital RTS, and NISS are significant predictors of death
after trauma. The time intervals between the accident and arrival at the hospital,
arrival at the hospital and the first computed tomography scan or the first crucial
emergency intervention, do not appear to affect the risk of death.
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Article Info
Publication History
Published online: July 29, 2013
Accepted:
June 6,
2013
Received in revised form:
May 31,
2013
Received:
May 22,
2013
Footnotes
☆Permission note (ethics): The study has been approved by the Ethics Committee of the Department of Health of the government of Navarre. The subjects gave their informed consent to the work.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
