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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
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
Corresponding

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.

Type
Original Research
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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