Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Abstract

Traumatic brain injuries are complex situations in which the emergency medical services must quickly determine the risk of deterioration using minimal diagnostic methods. The aim of this study is to analyze whether the use of early warning scores can help with decision-making in these dynamic situations by determining the patients who need the intensive care unit. A prospective, multicentric cohort study without intervention was carried out on traumatic brain injury patients aged over 18 given advanced life support and taken to the hospital. Our study included a total of 209 cases. The total number of intensive-care unit admissions was 50 cases (23.9%). Of the scores analyzed, the National Early Warning Score2 was the best result presented with an area under the curve of 0.888 (0.81–0.94; p < 0.001) and an odds ratio of 25.4 (95% confidence interval (CI):11.2–57.5). The use of early warning scores (and specifically National Early Warning Score2) can help the emergency medical services to differentiate traumatic brain injury patients with a high risk of deterioration. The emergency medical services should use the early warning scores routinely in all cases for the early detection of high-risk situations.

Comparison of the Performance of 24 Early Warning Scores with the Updated National Early Warning Score (NEWS2) for Predicting Unplanned Intensive Care Unit (ICU) Admission in Postoperative Brain Tumor Patients: A Retrospective Study at a Single Center

“…Our study showed that the NEWS2’s cutoff point was 7, which means postoperative brain tumor patients with a NEWS2 score ≥7 may have a high risk of unplanned ICU admission within 72 h. This is consistent with the clinical response to the NEWS2’s risk classification in the guideline published by Royal College of Physicians [ 17 ], which indicate that patients with a NEWS2 score ≥7 need to be considered for transfer to a high-level care facility, such as the ICU. This is in accordance with the results of Martín-Rodríguez et al for brain trauma patients within 48 h of an ICU transfer (cutoff=7) [ 25 ]. This finding indicates that 7 may be a reasonable NEWS2 threshold value for medical teams to identify postoperative brain tumor patients’ deterioration and increase their care level.…”

“…Regarding unexpected ICU transfer predictions, we found that the NEWS2 and NEWS had greater discriminatory power in brain tumor patients than other EWSs. These results are similar to the findings of Smith et al for emergency patients within 24 h of ICU admission (AUROC=0.857) [ 23 ] and to the results of Martín-Rodríguez et al for brain trauma patients transferred to the ICU (AUROC=0.888) [ 25 ]. The NEWS2 showed high sensitivity (0.768) and specificity (0.774), meaning that it can identify 76.8% of the patients at risk of being admitted to the ICU after brain tumor surgery and 77.4% of the patients not at high risk of clinical deterioration.…”

“…Silcock et al compared the predictive value of NEWS and quick Sepsis-related Organ Failure Assessment for ICU transfer and death of emergency patients [ 19 ]. Martín-Rodríguez et al reported the better performance of NEWS2 among 4 EWSs in predicting ICU admission of patients with brain trauma [ 25 ].…”

Performance of Modified Early Warning Score (MEWS) for Predicting In-Hospital Mortality in Traumatic Brain Injury Patients

“…Several studies have demonstrated that the GCS score was related to the mortality of patients with TBI [3,22]. In a study by Han et al, a GCS score of ≤5 was associated with mortality in most groups, and the GCS score of non-survivors was 4 (3)(4)(5)(6)(7)(8)(9) in this study [22]. In another study on patients with TBI, the OR of the GCS score for mortality was 0.765, similar to that obtained in the present study [3], in which the GCS score of nonsurvivors corresponded to the unresponsiveness parameter in the AVPU scale [23].…”

“…Several triage tools for TBI have been developed, and studies have reported the efficacies of these tools for predicting prognosis [ 3 , 4 , 5 , 6 , 7 , 8 ]. Among these, the Injury Severity Score (ISS) and Revised Trauma Score (RTS) are the most commonly used tools in severe trauma patients, including those with TBI [ 3 , 4 ].…”