Trauma Score change during transport: is it predictive of mortality?

The Trauma Score, a physiologic measure of injury severity, has been used to evaluate prehospital care by comparing the score before with the score after patient transport. To assess the value of the Trauma Score when used in this way, we compared the change in Trauma Score (TS change) during transport to eventual mortality in a group of injured patients. Patients transported by helicopter to the base hospital during a 22-month period had scores obtained on arrival of the flight crew (TS initial) and again on arrival at the emergency department (TS after transport). Stepwise logistic regression was used to test the predictive power for mortality of TS initial, TS after transport, and TS change. Of 387 patients transferred during the study period, 376 patients had complete information and were included in the analysis. Approximately 75% of patients had no TS change. The best predictor of mortality was TS after transport (F = 80.94, P less than .01). When TS after transport was removed as an explanatory variable, TS initial was found to have significant predictive power for mortality (F = 76.98, P less than .01), with TS change adding significantly to predictive power (F = 15.02, P less than .01). We conclude that because TS change is predictive of survival, it is potentially useful as an outcome measure to evaluate the impact of treatment during transport.