Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Inclusion/Exclusion Criteria
2.3. Ethical Approval
2.4. Scoring Systems
- Abbreviated Injury Scale (AIS);
- Injury Severity Score (ISS);
- New Injury Severity Score (NISS).
- Revised Trauma Score coded (RTSc);
- Acute Physiology and Chronic Health Evaluation II (APACHE II);
- Combined scores;
- Trauma and Injury Severity Score (TRISS).
2.5. Score Calculation
- Blunt trauma coefficient, −0.4499;
- RTSc coefficient, 0.8085;
- ISS coefficient, −0.0835;
- Age coefficient (if age > 54 years): −1.743.
2.6. Clinical Course/Clinical Parameters
2.7. Diagnosis and Management of Blunt Thoracic Aortic Injuries (BTAI)
2.8. Statistics
3. Results
3.1. Demographic Data
3.2. Mechanism of Injury
3.3. Aortic Injuries, Treatment of Blunt Aortic Injuries and Consequences of Stenting
3.4. Causes of Death
3.5. Logistic Regression
3.6. Correlation Analysis of Scores
3.7. Receiver Operating Characteristics Curves
- NISS, 0.812, (95%-CI, 0.689–0.935; asymptotic significance, 0.000*);
- ISS, 0.791 (95%-CI, 0.643–0.940; asymptotic significance, 0.001*);
- ISS without aortic injuries, 0.671 (95%-CI, 0.516–0.826; asymptotic significance 0.041*);
- APACHE II, 0.884 (95%-CI, 0.786–0.981; asymptotic significance 0.000*);
- RTSc, 0.679 (95%-CI, 0.486–0.872; asymptotic significance 0.140);
- TRISS, 0.761 (95%-CI, 0.577–0.945; asymptotic significance 0.030*);
- Shock index, 0.702 (95%-CI, 0.522–0.881; asymptotic significance 0.050).* significant
4. Discussion
4.1. Mortality
4.2. Abbreviated Injury Scale-Based Anatomic Scoring Systems
4.3. Physiologic Scoring Systems
4.4. Combined Scoring Systems
4.5. Limitations and Strength
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Study Population | |
---|---|---|
Male | Female | |
Number (n) | 56 | 9 |
Age (years); mean ± SD | 41.4 (±17.5) | 43.3 (±20.5) |
Sex; n (%) | 56 (86.2%) | 9 (13.8%) |
ISS; median (IQR) | 34 (18.25) | 45 (17) |
NISS; median (IQR) | 41 (17.75) | 50 (16) |
RTS; median (IQR) | 6.904 (1.874) | 3.867 (0.733) |
TRISS; median (IQR) | 82.75 (60.27) | 7.64 (11.67) |
APACHE II; mean median (IQR) | 22 (11.5) | 22 (9) |
ICU time (days); median (IQR) | 13 (19) | 24 (24) |
Hospitalization time (days); median (IQR) | 19.5 (19.75) | 24 (24) |
Ventilation (hours); median (IQR) | 230 (442) | 397 (555) |
Mortality; n (%) | 12 (21.4%) | 4 (44.4%) |
Types of Aortic Injuries | Frequency n (%) | Open Surgery n (%) | Endovascular Surgery n (%) | Conservative Therapy n (%) | Mortality n (%) |
---|---|---|---|---|---|
Aortic wall hematoma | 4 (6.2) | 0 (0) | 0 (0) | 4 (100) | 0 (0) |
Aortic wall rupture | 38 (58.5) | 6 (15.8) | 27 (71.1) | 5 (13.2) | 11 (29.0) |
Aortic dissection | 3 (4.6) | 0 (0) | 2 (66.7) | 1 (33.3) | 0 (0) |
Comb. rupture and dissection | 16 (24.6) | 3 (18.8) | 12 (75.0) | 1 (6.3) | 4 (25.0) |
Intimaflap | 2 (3.1) | 0 (0) | 0 (0) | 2 (100) | 0 (0) |
Abdominal aortic injury | 1 (1.5) | 1 (100) | 0 (0) | 0 (0) | 0 (0) |
Thoracic plaque rupture | 1 (1.5) | 0 (0) | 0 (0) | 1 (100) | 1 (100) * |
Overall | 65 (100) | 10 (15.39) | 41 (63.08) | 14 (21.54) | 16 (24.62) |
Number | Sex | Death after (days) | Cause of Death | ISS |
---|---|---|---|---|
1 | female | 1 | hemorrhagic shock due to retroperitoneal bleeding | 45 |
2 | male | 1 | secondary free aortic rupture | 75 a,b |
3 | female | 1 | secondary free aortic rupture | 75 a,b |
4 | male | 1 | traumatic brain injury | 75 |
5 | male | 1 | secondary free aortic rupture | 75 a,b |
6 | male | 1 | secondary free aortic rupture | 75 a,b |
7 | male | 1 | traumatic brain injury | 45 |
8 | male | 1 | hemorrhage after left pulmonary hilus rupture | 75 a |
9 | male | 2 | myocardial infarction caused by coronary artery disease | 26 |
10 | male | 2 | Traumatic brain injury | 45 |
11 | male | 2 | hypotension (therapy limitation due to advance healthcare directive) | 21 |
12 | male | 3 | respiratory failure | 50 |
13 | male | 3 | multiple organ dysfunction syndrome | 34 |
14 | female | 8 | traumatic brain injury | 57 |
15 | male | 37 | multiple organ dysfunction syndrome | 50 |
16 | female | 61 | multiple organ dysfunction syndrome | 36 |
Score | AUC | Sensitivity | Specificity | Odds Ratio | 95% Confidence Interval (ORS) |
---|---|---|---|---|---|
NISS | 0.812 | 0.375 | 0.980 | 1.117 | 0.050–0.171 * |
ISS | 0.791 | 0.438 | 0.959 | 1.096 | 0.041–0.142 * |
ISS w/o aorta | 0.671 | 0.125 | 1.000 | 1.059 | 0.007–0.107 * |
TRISS | 0.761 | 0.250 | 0.957 | 0.977 | −0.047–0.001 |
APACHE II | 0.880 | 0.545 | 0.938 | 1.089 | 0.034–0.136 * |
RTSc | 0.679 | 0.000 | 1.000 | 0,802 | –0.623–0.221 |
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Omar, A.; Winkelmann, M.; Liodakis, E.; Clausen, J.-D.; Graulich, T.; Omar, M.; Krettek, C.; Macke, C. Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries. Diagnostics 2021, 11, 2156. https://doi.org/10.3390/diagnostics11112156
Omar A, Winkelmann M, Liodakis E, Clausen J-D, Graulich T, Omar M, Krettek C, Macke C. Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries. Diagnostics. 2021; 11(11):2156. https://doi.org/10.3390/diagnostics11112156
Chicago/Turabian StyleOmar, Alexander, Marcel Winkelmann, Emmanouil Liodakis, Jan-Dierk Clausen, Tilman Graulich, Mohamed Omar, Christian Krettek, and Christian Macke. 2021. "Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries" Diagnostics 11, no. 11: 2156. https://doi.org/10.3390/diagnostics11112156
APA StyleOmar, A., Winkelmann, M., Liodakis, E., Clausen, J.-D., Graulich, T., Omar, M., Krettek, C., & Macke, C. (2021). Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries. Diagnostics, 11(11), 2156. https://doi.org/10.3390/diagnostics11112156