Pieter Joosse1, Willem-Jan J de Jong, Johannes B Reitsma, Klaus W Wendt, Niels W Schep, J Carel Goslings. 1. 1Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
Abstract
OBJECTIVES: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and prothrombin time. Our goal was to validate the Emergency Trauma Score in two large external cohorts. As the Injury Severity Score is not accurately known at the time patients present at the resuscitation room, we evaluated the performance of Emergency Trauma Score in all trauma patients. DESIGN: External validation study using data from two prospectively collected trauma registries. SETTING: Two academic level 1 trauma centers. PATIENTS: Adult patients admitted to the hospital after treatment at the trauma resuscitation room. INTERVENTION: Calibration and discrimination of the original Emergency Trauma Score were assessed within each cohort separately. MEASUREMENT AND MAIN RESULTS: A total of 4,418 consecutive patients were evaluated. Discrimination was good in both validation cohorts, with areas under the receiver-operating curve curves that were even higher (0.94 and 0.92, respectively) than that in the original cohort (0.83). Predicted mortality was systematically too high compared with actual mortality in patients with low-to-medium expected risk (< 25%). Calibration improved in the lower expected risk range after exclusion of patients with Injury Severity Score less than 16. CONCLUSIONS: The Emergency Trauma Score model performs well in discriminating between trauma patients who will survive and who will not. If applied to all trauma patients, predicted mortality risks are too high in the low-risk category.
OBJECTIVES: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult traumapatients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and prothrombin time. Our goal was to validate the Emergency Trauma Score in two large external cohorts. As the Injury Severity Score is not accurately known at the time patients present at the resuscitation room, we evaluated the performance of Emergency Trauma Score in all traumapatients. DESIGN: External validation study using data from two prospectively collected trauma registries. SETTING: Two academic level 1 trauma centers. PATIENTS: Adult patients admitted to the hospital after treatment at the trauma resuscitation room. INTERVENTION: Calibration and discrimination of the original Emergency Trauma Score were assessed within each cohort separately. MEASUREMENT AND MAIN RESULTS: A total of 4,418 consecutive patients were evaluated. Discrimination was good in both validation cohorts, with areas under the receiver-operating curve curves that were even higher (0.94 and 0.92, respectively) than that in the original cohort (0.83). Predicted mortality was systematically too high compared with actual mortality in patients with low-to-medium expected risk (< 25%). Calibration improved in the lower expected risk range after exclusion of patients with Injury Severity Score less than 16. CONCLUSIONS: The Emergency Trauma Score model performs well in discriminating between traumapatients who will survive and who will not. If applied to all traumapatients, predicted mortality risks are too high in the low-risk category.