The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data
Abstract
:1. Background
2. Methods
2.1. Ethics Statement
2.2. Study Population
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics with All Types Trauma
3.2. Characteristics of Patients with Head Injury
3.3. Characteristics of Patients without Head Injury
3.4. Predictive Accuracy for Mortality
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Total | Survival | p-Value | ||
---|---|---|---|---|---|
(n = 18,750) | No (n = 502) | Yes (n = 18,248) | |||
Age (years) | 55 (38, 69) | 65 (48, 77) | 54 (37, 68) | <0.001 | |
ISS | 9 (4, 11) | 25 (16, 29) | 9 (4, 10) | <0.001 | |
GCS | 15 (15, 15) | 6 (3, 14) | 15 (15, 15) | <0.001 | |
SBP (mmHg) | 147 (127, 170) | 153 (121, 184) | 147 (127, 169) | 0.122 | |
HR (times/min) | 85 (74, 97) | 94 (77, 114) | 84 (74, 96) | <0.001 | |
RR (times/min) | 18 (18, 20) | 19 (18, 20) | 18 (18, 20) | <0.001 | |
SI | 0.57 (0.47, 0.69) | 0.62 (0.48, 0.84) | 0.57 (0.47, 0.69) | <0.001 | |
rSI | 1.75 (1.44, 2.11) | 1.60 (1.19, 2.10) | 1.75 (1.45, 2.11) | <0.001 | |
rSIG | 25.46 (20.57, 30.98) | 9.39 (5.25, 19.79) | 25.64 (20.85, 31.09) | <0.001 | |
RTS | 7.84 (7.84, 7.84) | 5.97 (4.09, 7.44) | 7.84 (7.84, 7.84) | <0.001 | |
TRISS | 0.98 (0.97, 0.99) | 0.70 (0.37, 0.92) | 0.98 (0.97, 0.99) | <0.001 | |
Sex, n (%) | Female | 8150 (43.5%) | 203 (35.3%) | 7975 (43.7%) | <0.001 |
Male | 10,600 (56.5%) | 325 (64.7%) | 10,275 (56.3%) | ||
AIS (Head), n (%) | 0 | 13,407 (71.5%) | 87 (17.3%) | 13,320 (73.0%) | <0.001 |
1 | 1006 (5.4%) | 12 (2.4%) | 994 (5.5%) | ||
2 | 388 (2.1%) | 6 (1.2%) | 382 (2.1%) | ||
3 | 1280 (6.8%) | 27 (5.4%) | 1253 (6.9%) | ||
4 | 2129 (11.4%) | 122 (24.3%) | 2007 (11.0%) | ||
5 | 525 (2.8%) | 235 (46.8%) | 290 (1.6%) | ||
6 | 15 (0.1%) | 13 (2.6%) | 2 (0.01%) | ||
AIS (Face), n (%) | 0 | 16,003 (85.4%) | 438 (87.3%) | 15,565 (85.3%) | 0.002 |
1 | 873 (4.7%) | 10 (2.0%) | 863 (4.7%) | ||
2 | 1829 (9.8%) | 50 (10.0%) | 1779 (9.8%) | ||
3 | 45 (0.2%) | 4 (0.8%) | 41 (0.2%) | ||
AIS (Thorax), n (%) | 0 | 16,376 (87.3%) | 375 (74.7%) | 16,001 (87.7%) | <0.001 |
1 | 389 (2.1%) | 11 (2.2%) | 378 (2.1%) | ||
2 | 592 (3.2%) | 14 (2.89%) | 578 (3.2%) | ||
3 | 948 (5.1%) | 51 (10.2%) | 897 (4.9%) | ||
4 | 419 (2.2%) | 43 (8.6%) | 376 (2.1%) | ||
5 | 25 (0.1%) | 7 (1.4%) | 18 (0.1%) | ||
6 | 1 (0.01%) | 1 (0.2%) | 0 (0.0%) | ||
AIS (Abdomen), n (%) | 0 | 17,483 (93.2%) | 436 (86.9%) | 17,047 (93.4%) | <0.001 |
1 | 86 (0.5%) | 2 (0.4%) | 84 (0.5%) | ||
2 | 651 (3.5%) | 27 (5.4%) | 624 (3.4%) | ||
3 | 366 (2.0%) | 14 (2.8%) | 352 (1.9%) | ||
4 | 129 (0.7%) | 19 (3.8%) | 110 (0.6%) | ||
5 | 35 (0.2%) | 4 (0.8%) | 31 (0.2%) | ||
AIS (Extremity), n (%) | 0 | 5040 (26.9%) | 316 (63.0%) | 4724 (25.9%) | <0.001 |
1 | 1163 (6.2%) | 9 (1.8%) | 1154 (6.3%) | ||
2 | 7139 (38.1%) | 89 (17.7%) | 7050 (38.6%) | ||
3 | 5358 (28.6%) | 73 (14.5%) | 5285 (29.0%) | ||
4 | 43 (0.2%) | 12 (2.4%) | 31 (0.2%) | ||
5 | 7 (0.04%) | 3 (0.6%) | 4 (0.02%) | ||
AIS (External), n (%) | 0 | 17,027 (90.8%) | 465 (92.6%) | 16,562 (90.8%) | <0.001 |
1 | 1613 (8.6%) | 27 (5.4%) | 1586 (8.7%) | ||
2 | 85 (0.5%) | 2 (0.4%) | 83 (0.5%) | ||
3 | 12 (0.06%) | 0 (0.0%) | 12 (0.1%) | ||
4 | 3 (0.02%) | 0 (0.0%) | 3 (0.02%) | ||
5 | 5 (0.03%) | 4 (0.8%) | 1 (0.01%) | ||
6 | 5 (0.03%) | 4 (0.8%) | 1 (0.01%) |
Variables | Total | Survival | p-Value | ||
---|---|---|---|---|---|
(n = 2438) | No (n = 229) | Yes (n = 2209) | |||
Age (years) | 61 (45, 74) | 68 (54, 78) | 60 (44, 74) | <0.001 | |
ISS | 16 (9, 16) | 25 (16, 25) | 16 (9, 16) | <0.001 | |
GCS | 15 (11, 15) | 4 (3, 9) | 15 (13, 15) | <0.001 | |
SBP (mmHg) | 154 (134, 180) | 158 (133, 197) | 154 (135, 178) | 0.01 | |
HR (times/min) | 84 (74, 97) | 92 (75, 109) | 84 (74, 96) | <0.001 | |
RR (times/min) | 18 (18, 20) | 19 (17, 20) | 18 (18, 20) | 0.993 | |
SI | 0.55 (0.45, 0.66) | 0.56 (0.45, 0.73) | 0.55 (0.45, 0.66) | 0.111 | |
rSI | 1.83 (1.51, 2.24) | 1.77 (1.37, 2.23) | 1.83 (1.52, 2.24) | 0.111 | |
rSIG | 24.62 (17.75, 30.79) | 8.76 (5.56, 18.20) | 25.38 (19.22, 31.23) | <0.001 | |
RTS | 7.84 (6.90, 7.84) | 5.03 (4.09, 6.90) | 7.84 (7.84, 7.84) | <0.001 | |
TRISS | 0.97 (0.94, 0.99) | 0.68 (0.45, 0.89) | 0.97 (0.94, 0.99) | <0.001 | |
Sex, n (%) | Female | 906 (37.2%) | 380 (35.4%) | 16,866 (37.4%) | 0.605 |
Male | 1532 (62.8%) | 148 (64.6%) | 1384 (62.7%) | ||
AIS (Head), n (%) | 2 | 170 (7.0%) | 2 (0.9%) | 168 (7.6%) | <0.001 |
3 | 693 (28.4%) | 15 (6.6%) | 678 (30.7%) | ||
4 | 1253 (51.4%) | 68 (29.7%) | 1185 (53.6%) | ||
5 | 310 (12.7%) | 134 (58.5%) | 176 (8.0%) | ||
6 | 12 (0.5%) | 10 (4.4%) | 2 (0.1%) |
Variables | Total | Survival | p-Value | ||
---|---|---|---|---|---|
(n = 16,312) | No (n = 273) | Yes (n = 16,039) | |||
Age (years) | 54 (37, 68) | 61 (42, 77) | 54 (37, 67( | <0.001 | |
ISS | 9 (4, 9) | 29 (18, 34) | 8 (4, 9) | <0.001 | |
GCS | 15 (15, 15) | 7 (3, 15) | 15 (15, 15) | <0.001 | |
SBP (mmHg) | 146 (126, 168) | 146 (107, 176) | 146 (126, 168) | 0.023 | |
HR (times/min) | 85 (75, 97) | 96 (78, 117) | 85 (75, 96) | <0.001 | |
RR (times/min) | 18 (18, 20) | 20 (18, 20) | 18 (18, 20) | <0.001 | |
SI | 0.58 (0.48, 0.70) | 0.67 (0.51, 0.93) | 0.58 (0.48, 0.69) | <0.001 | |
rSI | 1.73 (1.43, 2.09) | 1.50 (1.07, 1.98) | 1.73 (1.44, 2.09) | <0.001 | |
rSIG | 25.56 (20.83, 31.00) | 10.69 (5.07, 20.43) | 25.67 (21.00, 31.09) | <0.001 | |
RTS | 7.84 (7.84, 7.84) | 5.97 (4.09, 7.84) | 7.84 (7.84, 7.84) | <0.001 | |
TRISS | 0.98 (0.97, 1.00) | 0.72 (0.36, 0.93) | 0.98 (0.97, 1.00) | <0.001 | |
Sex, n (%) | Female | 7244 (44.4%) | 351 (35.2%) | 9359 (44.6%) | 0.002 |
Male | 9068 (55.6%) | 177 (64.8%) | 8891 (55.4%) | ||
AIS (Head), n (%) | 0 | 13,407 (82.2%) | 87 (31.97%) | 13,320 (83.1%) | <0.001 |
1 | 1006 (6.2%) | 12 (4.4%) | 994 (6.2%) | ||
AIS (Face), n (%) | 0 | 13,721 (84.1%) | 214 (78.4%) | 13,507 (84.2%) | <0.001 |
1 | 717 (4.4%) | 5 (1.8%) | 712 (4.4%) | ||
2 | 1829 (11.2%) | 50 (18.3%) | 1779 (11.1%) | ||
3 | 45 (0.3%) | 4 (1.5%) | 41 (0.3%) | ||
AIS (Thorax), n (%) | 0 | 13,992 (85.8%) | 152 (55.7%) | 13,840 (86.3%) | <0.001 |
1 | 335 (2.1%) | 5 (1.8%) | 330 (2.1%) | ||
2 | 592 (3.6%) | 14 (5.1%) | 578 (3.6%) | ||
3 | 948 (5.8%) | 51 (18.7%) | 897 (5.6%) | ||
4 | 419 (2.6%) | 43 (15.8%) | 376 (2.3%) | ||
5 | 25 (0.2%) | 7 (2.6%) | 18 (0.1%) | ||
6 | 1 (0.01%) | 1 (0.4%) | 0 (0.0%) | ||
AIS (Abdomen), n (%) | 0 | 15,055 (92.3%) | 208 (76.2%) | 14,847 (92.6%) | <0.001 |
1 | 76 (0.5%) | 1 (0.4%) | 75 (0.5%) | ||
2 | 651 (4.0%) | 27 (9.9%) | 624 (3.9%) | ||
3 | 366 (2.2%) | 14 (5.1%) | 352 (2.2%) | ||
4 | 129 (0.8%) | 19 (7.0%) | 110 (0.7%) | ||
5 | 35 (0.2%) | 4 (1.5%) | 31 (0.2%) | ||
AIS (Extremity), n (%) | 0 | 2743 (16.8%) | 94 (34.4%) | 2649 (16.5%) | <0.001 |
1 | 1022 (6.3%) | 2 (0.7%) | 1020 (6.4%) | ||
2 | 7139 (43.8%) | 89 (32.6%) | 7050 (44.0%) | ||
3 | 5358 (32.9%) | 73 (26.7%) | 5285 (33.0%) | ||
4 | 43 (0.3%) | 12 (4.4%) | 31 (0.2%) | ||
5 | 7 (0.04%) | 3 (1.1%) | 4 (0.02%) | ||
AIS (External), n (%) | 0 | 14,818 (90.8%) | 246 (90.1%) | 14,572 (90.95%) | <0.001 |
1 | 1384 (8.5%) | 17 (6.2%) | 1367 (8.5%) | ||
2 | 85 (0.5%) | 2 (0.7%) | 83 (0.5%) | ||
3 | 12 (0.1%) | 0 (0.0%) | 12 (0.1%) | ||
4 | 3 (0.02%) | 0 (0.0%) | 3 (0.02%) | ||
5 | 5 (0.03%) | 4 (1.5%) | 1 (0.01%) | ||
6 | 5 (0.03%) | 4 (1.5%) | 1 (0.01%) |
Variables | Best Cutoff Point | Sensitivity (%) | Specificity (%) | AUC | |
---|---|---|---|---|---|
TRISS | All patients | 1 | 88.4 | 83.3 | 0.93 |
Head injury | 0.9 | 84.2 | 81.7 | 0.89 | |
No head injury | 0.9 | 93.1 | 75.8 | 0.92 | |
rSIG | All patients | 14.8 | 92.9 | 65.9 | 0.83 |
Head injury | 14.8 | 86.8 | 70.7 | 0.82 | |
No head injury | 14 | 94.5 | 61.5 | 0.83 | |
RTS | All patients | 7.7 | 90.7 | 75.1 | 0.85 |
Head | 6.5 | 88.5 | 71.6 | 0.85 | |
No Head | 7.7 | 92.7 | 69.6 | 0.83 | |
SI | All patients | 0.8 | 88.3 | 28.5 | 0.57 |
Head injury | 0.7 | 75.4 | 36.2 | 0.53 | |
No head injury | 0.8 | 86.9 | 38.1 | 0.63 |
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Wu, S.-C.; Rau, C.-S.; Kuo, S.C.H.; Chien, P.-C.; Hsieh, H.-Y.; Hsieh, C.-H. The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data. Int. J. Environ. Res. Public Health 2018, 15, 2346. https://doi.org/10.3390/ijerph15112346
Wu S-C, Rau C-S, Kuo SCH, Chien P-C, Hsieh H-Y, Hsieh C-H. The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data. International Journal of Environmental Research and Public Health. 2018; 15(11):2346. https://doi.org/10.3390/ijerph15112346
Chicago/Turabian StyleWu, Shao-Chun, Cheng-Shyuan Rau, Spencer C. H. Kuo, Peng-Chen Chien, Hsiao-Yun Hsieh, and Ching-Hua Hsieh. 2018. "The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data" International Journal of Environmental Research and Public Health 15, no. 11: 2346. https://doi.org/10.3390/ijerph15112346