Background With an increasing number of motor vehicle crashes, there is an urgent need in emergency departments (EDs) to assess patients with multiple trauma quickly, easily, and reliably. Trauma severity can range from a minor to major threats to life or bodily function. In-hospital mortality and trauma severity prediction in such cases is crucial in the ED for the management of multiple trauma and improvement of the outcome of these patients. Previous studies have examined the performance of Modified Early Warning Score (MEWS) or Circulation, Respiration, Abdomen, Motor, and Speech (CRAMS) score based solely on mortality prediction or injury severity prediction. However, to the best of our knowledge, the performances of both scoring systems on in-hospital mortality and trauma severity prediction have not been compared previously. This retrospective study evaluated the value of MEWS and CRAMS score to predict in-hospital mortality and trauma severity in patients presenting to the ED with multiple traumatic injuries. Methods All study subjects were multiple trauma patients. Medical data of 1,127 patients were analyzed between January 2014 and April 2018. The MEWS and CRAMS score were calculated, and logistic regression and receiver operating characteristic curve analysis were conducted to investigate their performances regarding in-hospital mortality and trauma severity prediction. Results For in-hospital mortality prediction, the areas under the receiver operating characteristic curve (AUROCs) for MEWS and CRAMS score were 0.90 and 0.91, respectively, indicating that both of them were good in-hospital mortality predictors. Further, our study indicated that the CRAMS score performed better in trauma severity prediction, with an AUROC value of 0.84, which was higher than that of MEWS (AUROC = 0.77). For trauma severity prediction, the optimal cut-off value for MEWS was 2, while that of the CRAMS score was 8. Conclusions We found that both MEWS and CRAMS score can be used as predictors for trauma severity and in-hospital mortality for multiple trauma patients, but that CRAMS score was superior to MEWS for trauma severity prediction. CRAMS score should be prioritized in the prediction of trauma severity due to its excellence as a multiple trauma triage tool and potential contribution to rapid emergency rescue decisions.
Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.
Effective triage tools are indispensable for doctors to make a prompt decision for the treatment of multiple trauma patients in emergency departments (EDs). The Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), standardized early warning score (SEWS), Modified Rapid Emergency Medicine Score (mREMS), and Revised Trauma Score (RTS) are five common triage tools proposed for trauma management. However, few studies have compared these tools in a multiple trauma cohort and investigated the influence of nighttime admission on the performance of these tools. This retrospective study was aimed at evaluating and comparing the performance of MEWS, NEWS, SEWS, mREMS, and RTS for identifying the mortality risk and trauma severity of patients with multiple trauma admitted to the ED during the daytime and nighttime. Retrospective data were collected from the medical records of patients with multiple trauma admitted in the daytime or nighttime to calculate scores for each triage tool. Logistic regression analysis was conducted on each triage tool for identifying in-hospital mortality and severe trauma (injury severity score > 15 ) in the daytime and nighttime. The performance of the tools was evaluated and compared by calculating area under the receiver operating characteristic curve (AUROC) of the retrospective logistic model of each tool. We collected data for 1,818 admissions, including 1,070 daytime and 748 nighttime admissions. A comparison of performance for identifying in-hospital mortality between daytime and nighttime yielded the following results (AUROC): MEWS (0.95 vs. 0.93, p = 0.384 ), NEWS (0.95 vs. 0.94, p = 0.708 ), SEWS (0.95 vs. 0.94, p = 0.683 ), mREMS (0.94 vs. 0.92, p = 0.286 ), and RTS (0.93 vs. 0.93, p = 0.87 ). Similarly, a comparison of performance for identifying trauma severity between daytime and nighttime yielded the following results (AUROC): MEWS (0.78 vs. 0.78, p = 0.95 ), NEWS (0.8 vs. 0.8, p = 0.885 ), SEWS (0.78 vs. 0.78, p = 0.818 ), mREMS (0.75 vs. 0.69, p = 0.019 ), and RTS (0.75 vs. 0.74, p = 0.619 ). All five scores are excellent triage tools ( AUROC ≥ 0.9 ) for identifying in-hospital mortality for both daytime and nighttime admissions. However, they have only moderate effectiveness ( AUROC < 0.9 ) at identifying severe trauma. The NEWS is the best triage tool for identifying severe trauma for both daytime and nighttime admissions. The MEWS, NEWS, SEWS, and RTS exhibited no significant differences in performance for identifying in-hospital mortality or severe trauma during the daytime or nighttime. However, the mREMS was better at identifying severe trauma during the daytime.
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