Application and Modification of Revised Trauma Score for Emergency Treatment of Trunk Injury_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Yidan , YANG Xiaoyan , SHI Yingkang.

1. Department of Thoracic Surgery，West China Hospital，Sichuan University，Chengdu 610041，P. R. China;;
2. Information Center，West China Hospital，Sichuan University，Chengdu 610041，P. R . China;;
3. Department of Cardiovascular Surgery，West China Hospital，Sichuan University，Chengdu 610041，P. R. China;

Corresponding author：

Keywords：

Trauma score; Revised trauma score; Trunk injury; Emergency surgery

DOI：

02-0181-04 DOI：10.7507/1007-4848.20130055

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Objective To testify the efficacy of revised trauma score （RTS） in evaluating the severity of trunk injury，analyze its inadequacy and make modifications to improve its specificity and accuracy in evaluating trunk injury. Methods Medical records of 278 patients undergoing emergency surgery for the treatment of trunk injury in West China Hospital of Sichuan University between January 2006 and June 2012 were retrospectively analyzed. There were 231 males and 47 females in the age of 1-75 （33.7±14.1） years. RTS was calculated for each patient. Hemoglobin （Hb） concentrations in these patients acquired at the emergency room were included to reflect the severity of blood loss. The correlations between RTS and patient response to treatment as well as RTS and prognosis were analyzed. Patient response to treatment and prognosis were compared between the normal RTS group and the abnormal RTS group. Univariate analysis was performed followed by multivariate analysis for the variables which may impact prognosis. Modified RTS was established by regression analysis. Results RTS was significantly correlated with patient response to treatment as well as prognosis. RTS was significantly correlated with the time duration between the onset of injury and the beginning of operation （r =0.249，P＜0.001）， thoracic and abdominal blood loss volume （r = -0.255，P＜0.001），fluid resuscitation volume （r = -0.244，P＜0.001） as well as length of ICU stay （r = -0.202，P=0.001）. Mortalities in patients with different RTS were statistically different （P=0.004）. In the patient group with normal RTS the mortality was 5.1%，which indicates the inadequacy of RTS in evaluating trunk injury. Univariate analysis revealed that both emergency room Hb and RTS were correlated with patients’ prognosis. After putting these two factors into the regression analysis，a new formula to calculate modified RTS is established：Logit （P death）=6.450-0.769×RTS-0.029×Emergency room Hb. Conclusion Modified RTS is more specific in evaluating trunk injury and maintains the advantages of simplicity and rapidness.

Citation： LIN Yidan,YANG Xiaoyan,SHI Yingkang.. Application and Modification of Revised Trauma Score for Emergency Treatment of Trunk Injury. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 181-184. doi: 02-0181-04 DOI：10.7507/1007-4848.20130055 Copy

1.	Champion HR， Sacco WJ， Copes WS， et al. A revision of the Trauma Score. J Trauma， 1989， 29 （5）：623-629.
2.	Watts HF， Kerem Y， Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. J Emergencies Trauma Shock， 2012， 5 （2）：291-297.
3.	Beuran M， Negoi I， Paun S， et al. Trauma Scores: a review of the literature. Chirurgia， 2012， 107 （3）：291-297.
4.	Theodorou D， Toutouzas K， Drimousis P， et al. Emergency room management of trauma patients in Greece：preliminary report of a national study. Resuscitation， 2009， 80 （3）：350-353.
5.	Wutzler S， Westhoff J， Lefering R， et al. Time intervals during and after emergency room treatment. An analysis using the trauma register　of the German Society for Trauma Surgery. Unfallchirurg， 2010， 113 （1）：36-43.
6.	Shi YK， Wang LL， Lin YD， et al. Challenges for rear hospital care of Wenchuan earthquake casualties：experience from West China Hospital. Chin J Traumatol， 2010， 13 （3）：131-136.
7.	Kondo Y， Abe T， Kohshi K， et al. 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 （4）：R191.
8.	Sloan EP， Koenigsberg M， Clark JM， et al. The use of the Revised Trauma Score as an entry criterion in traumatic hemorrhagic shock studies：data from the DCLHb clinical trials. Prehosp Disaster Med， 2012， 27 （4）：330-344.
9.	Champion HR， Sacco WJ， Carnazzo AJ， et al. Trauma score. Crit Care Med ， 1981， 9 （9）：672-676.
10.	Hußmann B， Waydhas C， Lendemans S. Emergency trauma room management in severely and most severely injured patients. A　multidisciplinary task. Med Klin Intensivmed Notfmed， 2012， 107 （3）：217-227.
11.	Hilbert P， Hofmann GO， zur Nieden K， et al. Coagulation management　of trauma patients with unstabile circulation：establishment of a hemoglobin-oriented standard operating procedure. Anaesthesist， 2012， 61 （8）：703-710.
12.	Kassavin DS， Kuo YH， Ahmed N. Initial systolic blood pressure and ongoing internal bleeding following torso trauma. J Emerg Trauma　Shock， 2011， 4 （1）：37-41.
13.	Vandromme MJ， Griffin RL， Weinberg JA， et al. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality：could prehospital measures improve trauma triage ?J Am Coll Surg， 2010， 210 （5）：861-867.
14.	Nejati A， Khalaj S， Azizkhani R， et al. Evaluating validity of clinical criteria for requesting chest X-rays in trauma patients referred to emergency room. Adv Biomed Res，2012， 1：22.
15.	Cohen R， Adini B， Radomislensky I， et al. Involvement of surgical　residents in the management of trauma patients in the emergency room：does the presence of an attending physician affect outcomes ? World J Surg， 2012， 36 （3）：539-547.

1. 　Champion HR， Sacco WJ， Copes WS， et al. A revision of the Trauma Score. J Trauma， 1989， 29 （5）：623-629.
2. 　Watts HF， Kerem Y， Kulstad EB. Evaluation of the revised trauma and injury severity scores in elderly trauma patients. J Emergencies Trauma Shock， 2012， 5 （2）：291-297.
3. 　Beuran M， Negoi I， Paun S， et al. Trauma Scores: a review of the literature. Chirurgia， 2012， 107 （3）：291-297.
4. 　Theodorou D， Toutouzas K， Drimousis P， et al. Emergency room management of trauma patients in Greece：preliminary report of a national study. Resuscitation， 2009， 80 （3）：350-353.
5. 　Wutzler S， Westhoff J， Lefering R， et al. Time intervals during and after emergency room treatment. An analysis using the trauma register　of the German Society for Trauma Surgery. Unfallchirurg， 2010， 113 （1）：36-43.
6. 　Shi YK， Wang LL， Lin YD， et al. Challenges for rear hospital care of Wenchuan earthquake casualties：experience from West China Hospital. Chin J Traumatol， 2010， 13 （3）：131-136.
7. 　Kondo Y， Abe T， Kohshi K， et al. 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 （4）：R191.
8. 　Sloan EP， Koenigsberg M， Clark JM， et al. The use of the Revised Trauma Score as an entry criterion in traumatic hemorrhagic shock studies：data from the DCLHb clinical trials. Prehosp Disaster Med， 2012， 27 （4）：330-344.
9. 　Champion HR， Sacco WJ， Carnazzo AJ， et al. Trauma score. Crit Care Med ， 1981， 9 （9）：672-676.
10. 　Hußmann B， Waydhas C， Lendemans S. Emergency trauma room management in severely and most severely injured patients. A　multidisciplinary task. Med Klin Intensivmed Notfmed， 2012， 107 （3）：217-227.
11. 　Hilbert P， Hofmann GO， zur Nieden K， et al. Coagulation management　of trauma patients with unstabile circulation：establishment of a hemoglobin-oriented standard operating procedure. Anaesthesist， 2012， 61 （8）：703-710.
12. 　Kassavin DS， Kuo YH， Ahmed N. Initial systolic blood pressure and ongoing internal bleeding following torso trauma. J Emerg Trauma　Shock， 2011， 4 （1）：37-41.
13. 　Vandromme MJ， Griffin RL， Weinberg JA， et al. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality：could prehospital measures improve trauma triage ?J Am Coll Surg， 2010， 210 （5）：861-867.
14. 　Nejati A， Khalaj S， Azizkhani R， et al. Evaluating validity of clinical criteria for requesting chest X-rays in trauma patients referred to emergency room. Adv Biomed Res，2012， 1：22.
15. 　Cohen R， Adini B， Radomislensky I， et al. Involvement of surgical　residents in the management of trauma patients in the emergency room：does the presence of an attending physician affect outcomes ? World J Surg， 2012， 36 （3）：539-547.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application and Modification of Revised Trauma Score for Emergency Treatment of Trunk Injury

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