External Validation of the TERMINAL-24 Score in Predicting Mortality in Patients with Multiple Trauma
DOI:
https://doi.org/10.31584/jhsmr.2023974Keywords:
early mortality, multiple trauma, prognostic factor, validationAbstract
Objective: A prediction model: “TERMINAL-24,” was developed and internally validated for use in predicting the early mortality of multiple trauma patients in the Emergency Department. In this study, this model’s external validity and generalizability was evaluated.
Material and Methods: A retrospective cohort was used for the construction of two datasets. Temporal external validation used the dataset from the same location at a different period, and geographic external validation used the dataset from a different location.
Results: In total, 1,932 patients underwent temporal external validation, with 14 (0.7%) patients dying within 8 hours, 35 (1.8%) patients died between 8 and 24 hours, and 1,883(97.5%) patients were alive at 24 hours. From this, 2,336 patients were eligible for geographical external validation, with 106 (4.5%) patients having died at the emergency room, 143 (6.1%) patients died in hospital and 2,087 (89.3%) patients survived. The TERMINAL-24 score was applied to both datasets, with a benchmark of 4 or higher (range 0-5). In the temporal dataset, this score showed a mortality of greater than 20% (specificity 0.97) area under the receiver operating characteristic curve (AuROC) 0.91 (95% confidence interval (CI) 0.85-0.96); whereas, it demonstrated a mortality of greater than 60% (specificity 0.99) AuROC 0.92 (95%CI 0.89-0.94) in the geographical dataset.
Conclusion: TERMINAL-24 was effective at predicting early death in the emergency room. It was successfully implemented within the same hospital; however, the cut-point should be adapted for application in other institutions with unspecified times of death. Prospective studies at different hospitals should be planned to generalize this scoring system for clinical practice.
References
Samuthtai W, Patumanond J, Samuthtai P, Charernboon T, Jearwattanakanok K, Khorana J. Clinical prediction scoring scheme for 24 h mortality in major traumatic adult patients. Healthcare (Basel) 2022;10:577. doi: 10.3390/healthcare10030577.
Iserson KV, Moskop JC. Triage in medicine, part i: concept, history, and types. Ann Emerg Med 2007;49:275-81. doi: 10.1016/j.annemergmed.2006.05.019.
Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med 1981;9:672-6.
Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma 1989;29:623-29. doi: 10.1097/00005373-198905000-00017.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187-96.
Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. revised trauma scoring system to predict in-hospital mortality in the emergency department: glasgow coma scale, age, and systolic blood pressure score. Crit Care 2011;15:191. doi:10.1186/cc10348.
Hunt RC. American college of surgeons committee on trauma. Advanced trauma life support program for doctors. 7th ed. Chicago: Thieme; 2004.
Abbasi H, Bolandparvaz S, Yadollahi M, Anvar M, Farahgol Z. Time distribution of injury-related in-hospital mortality in a trauma referral center in South of Iran (2010-2015). Medicine (Baltimore) 2017;96:e6871. doi: 10.1097/md.0000000000006871.
Arslan ED, Kaya E, Sonmez M, Kavalci C, Solakoglu A, Yilmaz F, et al. Assessment of traumatic deaths in a level one trauma center in Ankara, Turkey. Eur J Trauma Emerg Surg 2015;41:319-23. doi: 10.1007/s00068-014-0439-y.
Clark DE, Qian J, Sihler KC, Hallagan LD, Betensky RA. The distribution of survival times after injury. World J Surg 2012;36:1562-70. doi: 10.1007/s00268-012-1549-5.
Gomes E, Araujo R, Carneiro A, Dias C, Lecky FE, Costa-Pereira A. Mortality distribution in a trauma system: from data to health policy recommendations. Eur J Trauma Emerg Surg 2008;34:561-9. doi: 10.1007/s00068-007-6189-3.
Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent) 2010;23:349-54. doi: 10.1080/08998280.2010.11928649.
Kleber C, Giesecke MT, Tsokos M, Haas NP, Schaser KD, Stefan P, et al. Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management?. World J Surg 2012;36:2125-30. doi: 10.1007/s00268-012-1650-9.
Sobrino J, Shafi S. Timing and causes of death after injuries. Proc (Bayl Univ Med Cent) 2013;26:120-3. doi: 10.1080/08998280.2013.11928934.
Trajano AD, Pereira BM, Fraga GP. Epidemiology of in-hospital trauma deaths in a Brazilian university hospital. BMC Emerg Med 2014;14:22. doi: 10.1186/1471-227x-14-22.
Valdez C, Sarani B, Young H, Amdur R, Dunne J, Chawla LS. Timing of death after traumatic injury--a contemporary assessment of the temporal distribution of death. J Surg Res 2016;200:604-9. doi: 10.1016/j.jss.2015.08.031.
Raum MR, Nijsten MW, Vogelzang M, Schuring F, Lefering R, Bouillon B. Emergency trauma score: an instrument for early estimation of trauma severity. Crit Care Med 2009;37:1972-7. doi: 10.1097/CCM.0b013e31819fe96a.
Imhoff BF, Thompson NJ, Hastings MA, Nazir N, Moncure M, Cannon CM. Rapid emergency medicine score (REMS) in the trauma population: a retrospective study. BMJ Open 2014;4:e004738. doi: 10.1136/bmjopen-2013-004738.
Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoipe M. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 2010;38:831-7. doi: 10.1097/CCM.0b013e3181cc4a67.
Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg 2017;17:77. doi: 10.1186/s12893-017-0272-4.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
