Value of physiological scoring systems in prediction of long-term mortality in traumatic brain injury patients

Sahar Mirbaha, Alireza Baratloo, Parviz Karimi

Abstract


Introduction: Rapid acute physiological score (RAPS) and Worthing physiological scoring system (WPSS) models have received much attention in recent years. Yet, the value of these systems in outcome prediction of traumatic brain injury (TBI) patients has not been assessed. Therefore, the present study was designed aiming to compare the value of the 2 mentioned models in prediction of 6-month mortality of head trauma patients.

Methods: The present study is a diagnostic accuracy one evaluating head trauma patients presenting to emergency department. Each patient had a WPSS score and a RAPS score, and then the discriminatory powers of the 2 models with 95% confidence interval (95% CI) were compared.

Results: Data of 735 head trauma patients was assessed. During the 6-month follow-up, 48 (6.53%) patients died. Area under the curve of RAPS and WPSS in prediction of 6-month mortality were 0.93 (95% CI: 0.88-0.98) and 0.97 (95% CI: 0.96-0.98), respectively. The 2 evaluation models had similar value in prediction of mortality in head trauma patients (p = 0.10). The best cut off point for RAPS and WPSS in prediction of trauma patients’ mortality was 5 and 2, respectively. RAPS had sensitivity and specificity of 89.58 (95% CI: 76.56-96.10) and 85.15 (95% CI: 82.22-87.68), respectively. Sensitivity and specificity of WPSS model were 100.0 (95% CI: 90.77-100.0) and 87.92 (95% CI: 85.19-90.21), respectively.

Conclusion: Findings show that there is a significant correlation between physiological factors on admission and mortality of head trauma patients. In addition, it was determined that RAPS and WPSS physiological scoring systems have high value in prediction of mortality following TBI.


Keywords


Brain injuries; mortality; diagnosis; emergency service, hospital

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References


Bruns JJ, Jagoda AS. Mild traumatic brain injury. Mt Sinai J Med. 2009;76(2):129-37.

Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995;45(7):1253-60.

Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42(4):492-506.

Berger RP, Hymel K, Gao W-M. The Use of Biomarkers After Inflicted Traumatic Brain Injury: Insight into Etiology, Pathophysiology, and Biochemistry. Clin Pediatr Emerg Med. 2006;7(3):186-93.

Dash PK, Zhao J, Hergenroeder G, Moore AN. Biomarkers for the Diagnosis, Prognosis, and Evaluation of Treatment Efficacy for Traumatic Brain Injury. Neurotherapeutics. 2010;7(1):100-14.

DeFazio MV, Rammo RA, Robles JR, Bramlett HM, Dietrich WD, Bullock MR. The Potential Utility of Blood-Derived Biochemical Markers as Indicators of Early Clinical Trends After Severe Traumatic Brain Injury. World Neurosurg. 2014;81(1):151-8.

Schiavi P, Laccarino C, Servadei F. The value of the calcium binding protein S100 in the management of patients with traumatic brain injury. Acta Biomed. 2012;83(1):5-20.

de Souza Nogueira L, de Alencar Domingues C, Poggetti RS, de Sousa RMC. Nursing workload in intensive care unit trauma patients: analysis of associated factors. PLoS One. 2014;9(11):e112125.

Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Darafarin A, Esfahani MRA, et al. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis. Emergency. 2016;4(2):55-64.

Shojaee M, Dolatabadi AA, Sabzghabaei A, Malekirastekenari A, Faridaalaee G, Yousefifard M, et al. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chin J Traumatol. 2014;17(1):19-24.

Safari S, Yousefifard M, Hashemi B, Baratloo A, Forouzanfar MM, Rahmati F, et al. The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol. 2016;20(2):153-61.

Safari S, Yousefifard M, Baikpour M, Rahimi-Movaghar V, Abiri S, Falaki M, et al. Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma. J Clin Orthop Trauma. 2016;7(2):95-100.

Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of Ultrasonography and Radiography in Detection of Hemothorax: a Systematic Review and Meta-Analysis. Emergency. 2016;4(3):116-26.

Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari MJH, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. Emergency. 2015;3(4):127-36.

Safari S, Yousefifard M, Hashemi B, Baratloo A, Forouzanfar M, Rahmati F, et al. The Role of Scoring Systems and Urine Dipstick in Prediction of Rhabdomyolysis-induced Acute Kidney Injury: a Systematic Review. Iran J Kidney Dis. 2016;10(3):101-6.

Izadi A, Yousefifard M, Nakhjavan-Shahraki B, Baikpour M, Mirzay Razaz J, Hosseini M. Diagnostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Detection of Pediatric Acute Kidney Injury; a Systematic Review and Meta-Analysis. Int J Pediatr. 2016:3875-95.

Izadi A, Yousefifard M, Nakhjavan-Shahraki B, Baikpour M, Mirzay Razaz J, Ataei N, et al. Value of Plasma/Serum Neutrophil Gelatinase-Associated Lipocalin in Detection of Pediatric Acute Kidney Injury; a Systematic Review and Meta-Analysis. Int J Pediatr. 2016:3815-36.

Le Gall J-R, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, et al. A simplified acute physiology score for ICU patients. Crit Care Med. 1984;12(11):975-7.

Olsson T, Lind L. Comparison of the Rapid Emergency Medicine Score and APACHE II in Nonsurgical Emergency Department Patients. Acad Emerg Med. 2003;10(10):1040-8.

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(5):e004738.

Ha DT, Dang TQ, Tran NV, Vo NY, Nguyen ND, Nguyen TV. Prognostic performance of the Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) in emergency department. Int J Emerg Med. 2015;8(1):18.

Lefering R. Trauma scoring systems. Curr Opin Crit Care. 2012;18(6):637-40.

Duckitt R, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, et al. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br J Anaesth. 2007;98(6):769-74.

Cleves MA, Rock L. From the help desk: Comparing areas under receiver operating characteristic curves from two or more probit or logit models. Stata J. 2002;2(3):301-13.

Brabrand M, Hallas J, Knudsen T. Nurses and Physicians in a Medical Admission Unit Can Accurately Predict Mortality of Acutely Admitted Patients: A Prospective Cohort Study. PLoS One. 2014;9(7):e101739.


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