May 2014

Paul Jones, MD

MacTraumatic: Predicting Early Death in Trauma Patients

OBJECTIVE

• Does the simplified prognostic model developed by Perel et al. using Age, SBP and GCS accurately predict early death in HHS Trauma Registry patients?

Fig 4 Chart to predict death in trauma patients*.

Perel P et al. BMJ 2012;345:bmj.e5166

©2012 by British Medical Journal Publishing Group

* Excludes Middle and Low income countries

METHODS

• MY INCLUSION CRITIERA– Age > 15 years old <82– SBP < 90 mm Hg– HR > 110– Or both

METHODS

• Search HHS Trauma Registry between January 1, 2009 and March 31, 2013

• Total Trauma Registry Patients = 2871– Meeting Inclusion Criteria:

• Total n = 246

METHODSPREDICTORS:

– Age– Systolic Blood Pressure (SBP)– Glasgow Coma Scale (GCS)

OUTCOME:– Early Mortality

• Observed Risk of Death• Predicted Risk of Death

Baseline characteristics

1. = 15% mortality

2. TARN = 12% mortality

3. HHS = 13% morality

RESULTS

RESULTS

Fig 5 Internal and external calibration of simple chart.

Perel P et al. BMJ 2012;345:bmj.e5166

©2012 by British Medical Journal Publishing Group

Conclusions• The simplified model accurately predicts

early death in the HHS Trauma Registry.

• There was strong agreement between the predicted risk of death and the observed deaths in the HHS Trauma Registry.

References

• 1. Perel P, Prieto-Merino D, Shakur H, Clayton T, Lecky F, Bouamra O, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ 2012;345:e5166.

• 2. Moons, Karel G. M. ; Royston, Patrick ; Vergouwe, Yvonne ; et al. Prognosis and prognostic research: what, why, and how? BMJ. 2009 Feb 23;338:b375. doi: 10.1136/bmj.b375   

• 3. Royston P, Moons KGM, Altman DG, Vergouwe Y. Prognosis and prognostic research: developing a prognostic model. BMJ 2009;338:b604

• 4. Altman DG, Vergouwe Y, Royston P, Moons KG. Prognosis and prognostic research: validating a prognostic model. BMJ. 2009 May 28;338:b605. doi: 10.1136/bmj.b605.

Thank You

• Erich Hanel

• Angela Coates

• Kristen O’Brien

• David Prieto-Merino

BACKGROUND

• A large randomized placebo controlled trial among trauma patients with, or at risk of, significant haemorrhage, of the effects of antifibrinolytic treatment on death and transfusion requirement

• Double blind RCT, London School of Hygiene and Tropical Medicine

• 274 Hospitals, 40 Countries, • 20 211 adult trauma patients

BACKGROUND

Perel et al. developed and validated a prognostic model to predict early death in patients with traumatic bleeding1. Initially they developed a prognostic model development with 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury in CRASH-2 trial. They then externally validated their prognostic model with 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN) in the UK.

• Systolic blood pressure < 90 mm Hg

• or heart rate >110 beats per min

• or both

• or who were considered to be at risk of significant hemorrhage

• and who were within 8 hours of injury.

CRASH-2 INCLUSIONS