Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-20T04:17:39.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Blood Glucose Levels Combined with Triage Revised Trauma Score Improve the Outcome Prediction in Adults and in Elderly Patients with Trauma

Published online by Cambridge University Press:  21 December 2020

Marcello Covino Open the ORCID record for Marcello Covino [Opens in a new window] ,
Raffaella Zaccaria ,
Maria Grazia Bocci ,
Luigi Carbone ,
Enrico Torelli ,
Mariella Fuorlo ,
Andrea Piccioni ,
Michele Santoro ,
Claudio Sandroni  and
Francesco Franceschi
Marcello Covino*
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Raffaella Zaccaria
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Maria Grazia Bocci
Affiliation:
Department of Anesthesiology and Intensive Care Medicine – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Luigi Carbone
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Enrico Torelli
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Mariella Fuorlo
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Andrea Piccioni
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Michele Santoro
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma
Claudio Sandroni
Affiliation:
Department of Anesthesiology and Intensive Care Medicine – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma Università Cattolica del Sacro Cuore – Roma
Francesco Franceschi
Affiliation:
Emergency Department – Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma Università Cattolica del Sacro Cuore – Roma
*
Correspondence: Marcello Covino, MD, Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 1, 00168 – Roma, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

This study was aimed to assess if combining the evaluation of blood glucose level (BGL) and the Triage Revised Trauma Score (T-RTS) may result in a more accurate prediction of the actual clinical outcome, both in general adult population and in elderly patients with trauma.

Methods:

This is a retrospective cohort study, conducted in the emergency department (ED) of an urban teaching hospital, with an average ED admission rate of 75,000 patients per year. Those excluded: known diagnosis of diabetes, age <18 years old, pregnancy, and mild trauma (classified as isolate trauma of upper or lower limb, in absence of exposed fractures). A combined Revised Trauma Score Glucose (RTS-G) score was obtained adding to T-RTS: two for BGL <160mg/dL (8.9mmol/L); one for BGL ≥160mg/dL and < 200mg/dL (11.1mmol/L); and zero for BGL ≥ 200mg/dL. The primary outcome was a composite of patient’s death in ED or admission to intensive care unit (ICU). Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the overall performance of T-RTS and of the combined RTS-G score.

Results:

Among a total of 68,933 traumas, 9,436 patients (4,407 females) were enrolled, aged from 18 to 103 years; 4,288 were aged ≥65 years. A total of 577 (6.1%) met the primary endpoint: 38 patients died in ED (0.4%) and 539 patients were admitted to ICU. The T-RTS and BGL were independently associated to primary endpoint at multivariate analysis. The cumulative RTS-G score was significantly more accurate than T-RTS and reached the best accuracy in elderly patients. In general population, ROC area under curve (AUC) for T-RTS was 0.671 (95% CI, 0.661 - 0.680) compared to RTS-G ROC AUC 0.743 (95% CI, 0.734 - 0.752); P <.001. In patients ≥65 years, T-RTS ROC AUC was 0.671 (95% CI, 0.657 - 0.685) compared to RTS-G ROC AUC 0.780 (95% CI, 0.768 - 0.793); P <.001.

Conclusions:

Results showed RTS-G could be used effectively at ED triage for the risk stratification for death in ED and ICU admission of trauma patients, and it could reduce under-triage of approximately 20% compared to T-RTS. Comparing ROC AUCs, the combined RTS-G score performs significantly better than T-RTS and gives best results in patients ≥65 years.

Keywords

blood glucose levelelderlyRevised Trauma Scoretrauma triage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 2 , April 2021 , pp. 175 - 182
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME. A revision of the trauma score. J Trauma. 1989;29(5):623–629.CrossRefGoogle ScholarPubMed
Keel, M, Trentz, O. Pathophysiology of polytrauma. Injury. 2005;36(6):691–709.CrossRefGoogle ScholarPubMed
Wutzler, S, Maegele, M, Wafaisade, A, Wyen, H, Marzi, I, Lefering, R. Risk stratification in trauma and hemorrhagic shock: scoring systems derived from the TraumaRegister DGU. Injury. 2014;45(Suppl 3):S29–34.CrossRefGoogle ScholarPubMed
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(3);187-196.CrossRefGoogle ScholarPubMed
Manoochehry, S, Vafabin, M, Bitaraf, S, Amiri, A. A comparison between the ability of Revised Trauma Score and Kampala Trauma Score in predicting mortality: a meta-analysis. Arch Acad Emerg Med. 2019;7(1):e6.Google ScholarPubMed
Roorda, J, Van Beeck, E, Stapert, J, Ten Wolde, W. Evaluating performance of the revised trauma score as a triage instrument in the prehospital setting. Injury. 1996;27(3):163–167.CrossRefGoogle ScholarPubMed
Moore, L, Lavoie, A, Abdous, B, et al. Unification of the revised trauma score. J Trauma. 2006;61(3):718–722.CrossRefGoogle ScholarPubMed
Nakhjavan-Shahraki, B, Yousefifard, M, Hajighanbari, MJ, et al. Worthing Physiological Score vs Revised Trauma Score in outcome prediction of trauma patients: a comparative study. Emerg (Tehran). 2017;5(1):e31.Google ScholarPubMed
Jeong, JH, Park, YJ, Kim, DH, et al. The New Trauma Score (NTS): a modification of the Revised Trauma Score for better trauma mortality prediction. BMC Surg. 2017;17(1):77.CrossRefGoogle ScholarPubMed
Sartorius, D, Le Manach, Y, David, JS, et al. 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(3):831–837.CrossRefGoogle ScholarPubMed
Kobusingye, OC, Lett, RR. Hospital-Based trauma registries in Uganda. J Trauma-Injury Infect Crit Care. 2000;48(3):498–502.CrossRefGoogle ScholarPubMed
Kim, SC, Kim, DH, Kim, TY, et al. The Revised Trauma Score plus serum albumin level improves the prediction of mortality in trauma patients. Am J Emerg Med. 2017;35(12):1882–1886.CrossRefGoogle ScholarPubMed
Kreutziger, J, Lederer, W, Schmid, S, et al. Blood glucose concentrations in prehospital trauma patients with traumatic shock: a retrospective analysis. Eur J Anaesthesiol. 2018;35(1):33–42.CrossRefGoogle ScholarPubMed
Bar-Or, D, Rael, LT, Madayag, RM, et al. Stress hyperglycemia in critically ill patients: insight into possible molecular pathways. Front Med (Lausanne). 2019;6:54.CrossRefGoogle ScholarPubMed
Dungan, KM, Braithwaite, SS, Preiser, JC. Stress hyperglycemia. Lancet. 2009;373:1798–1807.CrossRefGoogle Scholar
Yendamuri, S, Fulda, GJ, Tinkoff, GH. Admission hyperglycemia as a prognostic indicator in trauma. J Trauma. 2003; 55:33–38.CrossRefGoogle ScholarPubMed
Paladino, L, Subramanian, RA, Nabors, S, Bhardwaj, S, Sinert, R. Triage hyperglycemia as a prognostic indicator of major trauma. J Trauma. 2010;69:41–45.Google ScholarPubMed
Laird, AM, Miller, PR, Kilgo, PD, Meredith, JW, Chang, MC. Relationship of early hyperglycemia to mortality in trauma patients. J Trauma. 2004;56:1058–1062.CrossRefGoogle ScholarPubMed
Sung, J, Bochicchio, GV, Joshi, M, Bochicchio, K, Tracy, K, Scalea, TM. Admission hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma. 2005;59:80–83.CrossRefGoogle ScholarPubMed
Rau, CS, Wu, SC, Chen, YC, et al. Mortality rate associated with admission hyperglycemia in traumatic femoral fracture patients is greater than non-diabetic normoglycemic patients but not diabetic normoglycemic patients. Int J Environ Res Public Health. 2018;15(1):28.CrossRefGoogle Scholar
Rau, CS, Wu, SC, Chen, YC, et al. Stress-Induced hyperglycemia, but not diabetic hyperglycemia, is associated with higher mortality in patients with isolated moderate and severe traumatic brain injury: analysis of a propensity score-matched population. Int J Environ Res Public Health. 2017;14:1340.CrossRefGoogle Scholar
Bochicchio, GV, Bochicchio, KM, Joshi, M, Ilahi, O, Scalea, TM. Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients. Ann Surg. 2010;252(4):597–602.CrossRefGoogle ScholarPubMed
Savić, J, Cernak, I, Jevtić, M, Todorić, M. Glucose as an adjunct triage tool to the Red Cross Wound Classification. J Trauma. 1996;40(3 Suppl):S144–147.CrossRefGoogle ScholarPubMed
DeLong, E, DeLong, D, Clarke-Pearson, D. Comparing the areas under two or more correlated Receiver Operating Characteristic curves: a nonparametric approach. Biometrics. 1988:44(3):837–845.CrossRefGoogle ScholarPubMed
Degroote, NE, Pieper, B. Blood glucose monitoring at triage. J Emerg Nurs. 1993;19(2):131–133.Google ScholarPubMed
Bochicchio, GV, Scalea, TM. Glycemic control in the ICU. Adv Surg. 2008;42:261–275.CrossRefGoogle ScholarPubMed
Shi, J, Dong, B, Mao, Y, et al. Review: traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget. 2016;7(43):71052–71061.CrossRefGoogle ScholarPubMed
Sperry, JL, Frankel, HL, Vanek, SL, et al. Early hyperglycemia predicts multiple organ failure and mortality but not infection. J Trauma. 2007;63(3):487–494.Google Scholar
Glassberg, E, Lipsky, AM, Lending, G, et al. Blood glucose levels as an adjunct for prehospital field triage. Am J Emerg Med. 2013;31(3):556–661.CrossRefGoogle ScholarPubMed
Kreutziger, J, Schmid, S, Umlauf, N, et al. Association between blood glucose and cardiac rhythms during pre-hospital care of trauma patients. A retrospective analysis. Scand J Trauma Resusc Emerg Med. 2018;26(1):58.CrossRefGoogle ScholarPubMed
Abu-Zidan, FM. Searching for mortality predictors in trauma patients: a challenging task. Eur J Trauma Emerg Surg. 2018;44(4):561–565.Google Scholar
Winearls, J, Campbell, D, Hurn, C, et al. Fibrinogen in traumatic hemorrhage: a narrative review. Injury. 2017;48(2):230–242.CrossRefGoogle ScholarPubMed
Tominaga, GT, Dandan, IS, Schaffer, KB, Nasrallah, F, Gawlik, RNM, Kraus, JF. Trauma resource designation: an innovative approach to improving trauma system over-triage. Trauma Surg Acute Care Open. 2017;2(1):e000102.CrossRefGoogle Scholar