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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 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: Marcello.covino@policlinicogemelli.it
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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
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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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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