Severity indexes of blunt trauma victims in intensive therapy: prediction capacity for mortality

Lima, Kézia Porto; Nogueira, Lilia de Souza; Barbosa, Genesis; Bonfim, Ane Karoline Silva; Sousa, Regina Marcia Cardoso de

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Revista da Escola de Enfermagem da USP

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Original Article • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020003203747 copy

Severity indexes of blunt trauma victims in intensive therapy: prediction capacity for mortality^* * Extracted from the dissertation: “Índices de gravidade em vítimas de trauma internadas em Unidade de Terapia Intensiva”, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, Universidade de São Paulo, 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the predictive capacity for mortality of the indexes Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score, and Simplified Acute Physiology Score III in blunt trauma victims hospitalized in an intensive care unit and compare their performance.

Method:

Retrospective cohort of patients with blunt trauma in an intensive care unit from medical records. Receiver Operating Characteristic and a 95% confidence interval of the area under the curve were analyzed to compare results.

Results:

Out of 165 analyzed patients, 66.7% have received surgical treatment. The mortality in the intensive care unit and in the hospital was 17.6% and 20.6%, respectively. For the mortality in the intensive care unit, the area under the curve varied from 0.672 to 0.738; however, better results have been observed in surgical patients (0.747 to 0.811). Similar results have been observed for in-hospital mortality. In all analyses, the areas under the curve of the indexes presented no significant difference.

Conclusion:

The accuracy of the severity indexes was moderate, with an improved performance when applied to surgical patients. The four indexes presented a similar prediction for the analyzed outcomes.

DESCRIPTORS
Wounds and Injuries; Severity of Illness Index; Trauma Severity Indexes; Mortality; Prognosis; ROC Curve

ROC Metrics	ICU Mortality
ROC Metrics	RTS	REMS	mREMS	SAPS III
AUC/ROC	0.682	0.672	0.738	0.731
95%CI	0.574–0.789	0.569–0.775	0.646–0.831	0.646–0.815
Cut point	6.2	5.5	4.5	44.5
Sensitivity	78.6%	69.1%	52.9%	49.3%
Specificity	55.9%	64.3%	89.3%	92.9%
PPV	26.8%	90.4%	96.0%	97.1%
PNV	92.7%	30.0%	28.1%	27.4%
ROC Metrics	In-hospital mortality
ROC Metrics	RTS	REMS	mREMS	SAPS III
AUC/ROC	0.646	0.637	0.688	0.734
CI95%	0.541–0.752	0.535–0.738	0.589–0.787	0.652–0.816
Cut point	6.2	5.5	6.5	44.5
Sensitivity	72.7%	68.7%	74.8%	50.4%
Specificity	55.7%	57.6%	57.6%	90.9%
PPV	29.3%	86.5%	87.5%	95.6%
PNV	89.0%	31.7%	36.5%	31.6%

ROC Metrics	ICU Mortality
ROC Metrics	RTS	REMS	mREMS	SAPS III
AUC/ROC	0.747	0.753	0.802	0.811
CI95%	0.627–0.868	0.636–0.870	0.697–0.907	0.726–0.896
Cut point	6.2	5.5	4.5	44.5
Sensitivity	80.0%	82.0%	65.2%	60.7%
Specificity	68.5%	65.0%	90.0%	95.0%
PPV	36.4%	91.2%	96.7%	98.2%
PNV	93.8%	44.8%	36.7%	35.2%
ROC Metrics	In-hospital mortality
ROC Metrics	RTS	REMS	mREMS	SAPS III
AUC/ROC	0.703	0.706	0.737	0.818
CI95%	0.584–0.822	0.589–0.824	0.622–0.852	0.736–0.900
Cut point	6.2	5.5	6.5	44.5
Sensitivity	72.0%	82.1%	84.5%	63.1%
Specificity	69.0%	56.0%	56.0%	92.0%
PPV	40.9%	86.2%	86.6%	96.4%
PNV	89.2%	48.3%	51.8%	42.6%

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Genesis Barbosa, Av. Aloísio da Silva Gomes, 50, Granja dos Cavaleiros CEP 27930-560 – Macaé, RJ, Brazil. genesis@ufrj.br