PROGNOSTIC VALUE OF UPDATED

TRAUMA SCORE IN EMERGENCY CASES

(AT SOETOMO HOSPITAL)
FENDY
SURGEON
TRAUMA OBSERVER
SOETOMO HOSPITAL
 Emergency dept/ hospital

police
ambulance

people
Other Vehicles
• MOI Trauma center

Trauma accident place

TRANSPORT PATIENT MONITOR ??

TIME RESPONSE?? PROGNOSTIC VALUE??

 PATIENT OUTCOMES

• TIME RESPONSE
• TRANSPORT PATIENT
• SOP
• HUMAN RESOURCES
• SKILL / TRAINING
• LEADERSHIP
• DEVICE EQUIPMENT
• COMMUNICATION PRE /INTRA HOSPITAL
• FINANCE ( INSURANCE/PRIVATE)
TRAUMA SCORING SYSTEMS
INJURY SEVERITY SCORE (ISS)

1 MINOR

2 MODERATE

ISS Body Regions: 3 SERIOUS

• Head or neck - Face 4 SEVERE

• Abdominal - Chest 5 CRITICAL

6 MAXIMUM INJURY,
• Extremities - External VIRTUALLY UNSURVIVABLE

Score = sum of squares of the 3 worst affected regions.

If one region= 6 then total score=75
INJURY SEVERITY SCORE (ISS)

Interpretation
• Minor <9
• Moderate 10-25
• Severe 26-34
• Very severe > 35

Score = sum of squares of the 3 worst affected regions. If one region=6 then total score=75
USEFULNESS ISS

• Comparison of different hospitals

• Comparison of same hospital over time
• May aid prognosis
 CRITICISMS OF THE ISS

Does not take into account : multiple injuries within a body system
age
co-morbidities

Penetrating trauma ?
Severe head injuries?
 THE NEW INJURY SEVERITY SCORE (NISS)

• Sums of squares of the 3 highest AIS scores

regardless of body region
• Performs slightly better in mortality prediction
 ISS VS. NISS

AIS SCORE REGION

Multiple abrasions 1 External

Deep laceration tongue 2 Face
Subarachnoid hemorrhage 3 Head/Neck
Major kidney laceration 4 Abdomen
Major liver laceration 4 Abdomen

ISS = (4)2 + (3)2 + (2)2 = 29

NISS = (4)2 + (4)2 + (3)2 = 41
PROBABILITY OF SURVIVAL MODELS

TRISS ( Trauma and injury severity score)

 ASCOT (A Severity Characterisation of Trauma)

REVISED TRAUMA SCORE

a physiological measurement
- based on data at arrival to hospital
considers:
Respiratory rate
Systolic blood pressure
Glasgow Coma Scale
REVISED TRAUMA SCORE
ASSESSING RTS MAY BE PROBLEMATIC

Accurate GCS and RR difficult when:

• the patient is intubated,
• chemically paralyzed ,
• under the influence of drugs or alcohol
SOETOMO HOSPITAL’ TRAUMA CENTER 2010-2018
Jenis Kelamin

Frequency Percent Valid Percent Cumulative Percent

Valid Laki Laki 932 79.1 79.1 79.1
Perempuan 246 20.9 20.9 100.0
Total 1178 100.0 100.0

Tahun Kejadian
Frequency Percent Valid Percent Cumulative Percent
Valid 2010 97 8.2 8.2 8.2
2011 129 11.0 11.0 19.2
2012 146 12.4 12.4 31.6
2013 161 13.7 13.7 45.2
2014 118 10.0 10.0 55.3
2015 164 13.9 13.9 69.2
2016 130 11.0 11.0 80.2
2017 85 7.2 7.2 87.4
2018 148 12.6 12.6 100.0
Total 1178 100.0 100.0
 Response Time Outcome

Cumulative Cumulative

Frequency Percent Valid Percent Percent Frequency Percent Valid Percent Percent

Valid < 1jam 1022 86.8 87.0 87.0 Valid Sembuh 938 79.6 79.6 79.6

> 1jam 153 13.0 13.0 100.0 Meninggal 240 20.4 20.4 100.0

Total 1175 99.7 100.0 Total 1178 100.0 100.0

Total 1178 100.0

 Outcome Crosstabulation kelompok usia
Cumulative
Count Frequency Percent Valid Percent Percent

? Outcome

Meningga
Valid Pediatri (0-17th)
dewasa (18-60th)
207
915
17.6
77.7
17.6
77.7
17.6
95.2
Geriatri (>60 th) 56 4.8 4.8 100.0
Sembuh l Total
Total 1178 100.0 100.0
RTS Immediate (3-
819 222 1041
10)

Urgent (11) 47 3 50
Delayed (12) 65 13 78
Dead (0-3) 0 1 1
Total 931 239 1170

Chi-Square Tests

Asymptotic
Significance (2-
Value df sided)
Pearson Chi-Square 11.494a 3 .009
Likelihood Ratio 12.713 3 .005
Linear-by-Linear
2.106 1 .147
Association

N of Valid Cases 1170

 CRITICISMS

• Valid Data
• Paediatric trauma
• Penetrating trauma
HOW TO CALCULATE
NEED NOVEL TRAUMA SCORE ?
• TIME RESPONSE
• TRANSPORT PATIENT
• SOP
• HUMAN RESOURCES
• SKILL / TRAINING
• LEADERSHIP
• DEVICE EQUIPMENT
• COMMUNICATION PRE /INTRA HOSPITAL
• FINANCE ( INSURANCE/PRIVATE)
• AMR
 NEW TRAUMA SCORE (NTS)

• Actual GCS
• Revision of systolic blood pressure interval
• Incorporation of peripheral oxygen saturation (SpO2)
• MGAP ?
• GAP ?
THANK YOU