Derivation and Validation of a Score Using Prehospital Data to Identify Adults With Trauma Requiring Early Laparotomy

• DOI: 10.1001/jamanetworkopen.2021.45860
• Publication Date: 2022-01-31T16:33:17Z
• Authors: Adam Gutierrez; Kazuhide Matsushima; Areg Grigorian; Morgan Schellenberg; Kenji Inaba
• Keywords: Triage; Trauma Center; Major trauma

<h3>Importance</h3> A scoring tool to identify which adults with traumatic injury will require early laparotomy could help improve prehospital triage and system readiness. <h3>Objective</h3> To develop validate a prediction model using information for following trauma. <h3>Design, Setting, Participants</h3> This retrospective cohort study analyzed data from the 2017 version of American College Surgeons Trauma Quality Improvement Program database. All adult patients aged 18 years or older who were admitted US trauma center in included. Patients randomly assigned derivation validation cohort. Data collected between July 2020 September 2020. <h3>Main Outcomes Measures</h3> The primary outcome was within 2 hours hospital arrival. developed predict logistic regression validated area under receiver operating characteristic curve. <h3>Results</h3> total 379 890 included; 190 264 189 626 cohorts had same proportion arrival (1.1%). median (IQR) age 32 (25-46) group 54 (33-72) no laparotomy. contained 113 776 188 211 (60.5%) male patients, while 1702 2053 (82.9%) patients. variable most strongly associated penetrating head, neck, torso, extremities proximal elbow knee (odds ratio, 13.47; 95% CI, 12.22-14.86) point value 10 (maximum overall score 20). Other variables included sex, systolic blood pressure less than 90 mm Hg, Glasgow Coma Scale equal 13, having chest wall instability deformity, pelvic fracture, high-risk blunt mechanism. In cohort, C statistic 0.78 (95% 0.77-0.79). <h3>Conclusions Relevance</h3> this study, novel derived may professionals allocate operative team resources before patient