Trauma Early Mortality Prediction Tool (TEMPT) for assessing 28-day mortality

Abstract

BackgroundPrior mortality prediction models have incorporated severity of anatomic injury quantified by Abbreviated Injury Severity Score (AIS). Using a prospective cohort, a new score independent of AIS was developed using clinical and laboratory markers present on emergency department presentation to predict 28-day mortality.MethodsAll patients (n=1427) enrolled in an ongoing prospective cohort study were included. Demographic, laboratory, and clinical data were recorded on admission. True random number generator technique divided the cohort into derivation (n=707) and validation groups (n=720). Using Youden indices, threshold values were selected for each potential predictor in the derivation cohort. Logistic regression was used to identify independent predictors. Significant variables were equally weighted to create a new mortality prediction score, the Trauma Early Mortality Prediction Tool (TEMPT) score. Area under the curve (AUC) was tested in the validation group. Pairwise comparison of Trauma Injury Severity Score (TRISS), Revised Trauma Score, Glasgow Coma Scale, and Injury Severity Score were tested against the TEMPT score.ResultsThere was no difference between baseline characteristics between derivation and validation groups. In multiple logistic regression, a model with presence of traumatic brain injury, increased age, elevated systolic blood pressure, decreased base excess, prolonged partial thromboplastin time, increased international normalized ratio (INR), and decreased temperature accurately predicted mortality at 28 days (AUC 0.93, 95% CI 0.90 to 0.96, P<0.001). In the validation cohort, this score, termed TEMPT, predicted 28-day mortality with an AUC 0.94 (95% CI 0.92 to 0.97). The TEMPT score preformed similarly to the revised TRISS score for severely injured patients and was highly predictive in those having mild to moderate injury.DiscussionTEMPT is a simple AIS-independent mortality prediction tool applicable very early following injury. TEMPT provides an AIS-independent score that could be used for early identification of those at risk of doing poorly following even minor injury.Level of evidenceLevel II.

Intentional Injuries in Trauma Carry a Higher Risk of Mortality

“…Patients with intentional injury were more severely injured, had higher ISS, lower GCS and were more likely to be in shock in the emergency department. This is certainly consistent with preexisting models for predicting mortality, based on parameters such as ISS [4] .…”

“…There are several predictive models to identify risk factors for mortality in the context of trauma, such as Trauma Injury Severity Score (TRISS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) [4]. Most of these models identify physiological parameters such as low GCS, presence of shock and on-going hemorrhage, or organ related injuries as potential risk factors for mortality [4][5][6][7][8].…”

Independent Predictors of Mortality in Torso Trauma Injuries

“…Base excess and ISS are well-known predictors of death in trauma patients [ 13 , 14 ] and our results underline once again their impact on mortality. In our analysis, BE was highlighted as a strong protective factor ( p = 0.008) for death, with a 7% drop of the risk per unitary increase.…”

Factors predicting the early mortality of trauma patients

“…[17,[23][24][25] One recent study proposed an early mortality prediction model for trauma patients based on clinical and laboratory values, as in the present study. [26] This model was simple and included some variables that were similar to those used in our study for trauma mortality prediction. However, that study evaluated the 28-day mortality, not 24-hour mortality.…”