Catherine M Kuza1, Kazuhide Matsushima2, Wendy J Mack3, Christopher Pham4, Talia Hourany4, Jessica Lee4, Thang D Tran4, Roman Dudaryk5, Michelle B Mulder5, Miguel A Escanelle5, Babatunde Ogunnaike6, M Iqbal Ahmed7, Xi Luo6, Alexander Eastman8, Jonathan B Imran8, Emily Melikman6, Abu Minhajuddin9, Anne Feeler6, Richard D Urman10, Ali Salim11, Dean Spencer12, Viktor Gabriel12, Divya Ramakrishnan12, Jeffry T Nahmias12. 1. Department of Anesthesiology, Keck School of Medicine of the University of Southern California (USC), 1450 San Pablo St., Suite 3600, Los Angeles, CA, 90033, USA. Electronic address: Catherine.kuza@gmail.com. 2. Department of Surgery, Keck School of Medicine of USC, 1450 San Pablo St., Suite 3600, Los Angeles, CA, 90033, USA. 3. Department of Preventive Medicine, Keck School of Medicine of USC, 1450 San Pablo St., Suite 3600, Los Angeles, CA, 90033, USA. 4. Department of Anesthesiology, Keck School of Medicine of the University of Southern California (USC), 1450 San Pablo St., Suite 3600, Los Angeles, CA, 90033, USA. 5. Division of Trauma Anesthesia, Department of Anesthesiology, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA. 6. Department of Anesthesiology & Pain Management, The Rees-Jones Trauma Center, Parkland Health and Hospital System, 5201 Harry Hines Blvd, Dallas, TX, 75235, USA. 7. Department of Anesthesiology, Cardiac Anesthesia Division, Children's Medical Center, UTSW Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. 8. Division of Burns, Trauma, & Critical Care, Rees-Jones Trauma Center at Parkland, UTSW Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. 9. Department of Clinical Sciences, UTSW Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA. 10. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 11. Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 12. Department of Surgery, Division of Trauma, Burns, & Surgical Critical Care, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA, 92868, USA.
Abstract
BACKGROUND: Trauma prediction scores such as Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS)) are used to predict mortality, but do not include comorbidities. We analyzed the American Society of Anesthesiologists physical status (ASA PS) for predicting mortality in trauma patients undergoing surgery. METHODS: This multicenter, retrospective study compared the mortality predictive ability of ASA PS, RTS, Injury Severity Score (ISS), and TRISS using a complete case analysis with mixed effects logistic regression. Associations with mortality and AROC were calculated for each measure alone and tested for differences using chi-square. RESULTS: Of 3,042 patients, 230 (8%) died. The AROC for mortality for TRISS was 0.938 (95%CI 0.921, 0.954), RTS 0.845 (95%CI 0.815, 0.875), and ASA PS 0.886 (95%CI 0.864, 0.908). ASA PS + TRISS did not improve mortality predictive ability (p = 0.18). CONCLUSIONS: ASA PS was a good predictor of mortality in trauma patients, although combined with TRISS it did not improve predictive ability.
BACKGROUND:Trauma prediction scores such as Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS)) are used to predict mortality, but do not include comorbidities. We analyzed the American Society of Anesthesiologists physical status (ASA PS) for predicting mortality in traumapatients undergoing surgery. METHODS: This multicenter, retrospective study compared the mortality predictive ability of ASA PS, RTS, Injury Severity Score (ISS), and TRISS using a complete case analysis with mixed effects logistic regression. Associations with mortality and AROC were calculated for each measure alone and tested for differences using chi-square. RESULTS: Of 3,042 patients, 230 (8%) died. The AROC for mortality for TRISS was 0.938 (95%CI 0.921, 0.954), RTS 0.845 (95%CI 0.815, 0.875), and ASA PS 0.886 (95%CI 0.864, 0.908). ASA PS + TRISS did not improve mortality predictive ability (p = 0.18). CONCLUSIONS:ASA PS was a good predictor of mortality in traumapatients, although combined with TRISS it did not improve predictive ability.