Predictors of mortality for blunt trauma patients in intensive care: a retrospective cohort study [version 3; peer review: 1 approved, 1 approved with reservations]
Predictors of mortality for blunt trauma patients in intensive care: a retrospective cohort study [version 3; peer review: 1 approved, 1 approved with reservations]
Background: major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care.
Methods: this was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression.
Results: a total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p <0.001) and GCS <15 on admission (OR 7.21, p <0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90.
Conclusions: the significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.
Jennings, Michael
fbf12ac7-5c03-4523-b89b-7f4d007e46c3
Booker, James
5d05bf89-80c0-4dc2-81ec-1bdb94d435cd
Addison, Amy
2697e3ac-21de-420a-bbbe-d447ece91068
Egglestone, Rebecca
64db0e24-5f71-4fe0-85f3-9fd1bf7b46c3
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
1 October 2024
Jennings, Michael
fbf12ac7-5c03-4523-b89b-7f4d007e46c3
Booker, James
5d05bf89-80c0-4dc2-81ec-1bdb94d435cd
Addison, Amy
2697e3ac-21de-420a-bbbe-d447ece91068
Egglestone, Rebecca
64db0e24-5f71-4fe0-85f3-9fd1bf7b46c3
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Jennings, Michael, Booker, James, Addison, Amy, Egglestone, Rebecca and Dushianthan, Ahilanandan
(2024)
Predictors of mortality for blunt trauma patients in intensive care: a retrospective cohort study [version 3; peer review: 1 approved, 1 approved with reservations].
F1000Research, 12 (974).
(doi:10.12688/f1000research.138364.3).
Abstract
Background: major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care.
Methods: this was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression.
Results: a total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p <0.001) and GCS <15 on admission (OR 7.21, p <0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90.
Conclusions: the significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.
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Published date: 1 October 2024
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First published: 14 Aug 2023, 12:974 (https://doi.org/10.12688/f1000research.138364.1)
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Local EPrints ID: 494465
URI: http://eprints.soton.ac.uk/id/eprint/494465
ISSN: 2046-1402
PURE UUID: dcc36750-0397-4f16-86bb-3bd094c5b200
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Date deposited: 09 Oct 2024 16:34
Last modified: 10 Oct 2024 01:55
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Author:
Michael Jennings
Author:
James Booker
Author:
Amy Addison
Author:
Rebecca Egglestone
Author:
Ahilanandan Dushianthan
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