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Am J Emerg Med. 2019 Mar 8. pii: S0735-6757(19)30156-1. doi: 10.1016/j.ajem.2019.03.007. [Epub ahead of print]

Prehospital quick sequential organ failure assessment score to predict in-hospital mortality among patients with trauma.

Author information

1
Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama-City, Wakayama 641-8509, Japan. Electronic address: gomadofu@wakayama-med.ac.jp.
2
Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama-City, Wakayama 641-8509, Japan.
3
Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama-City, Wakayama 641-8509, Japan. Electronic address: nakanaka@wakayama-med.ac.jp.
4
Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama-City, Wakayama 641-8509, Japan. Electronic address: katos@wakayama-med.ac.jp.

Abstract

OBJECTIVE:

The quick sequential organ failure assessment (qSOFA) score is calculated from three variables measured at the scene of trauma-systolic blood pressure, respiratory rate and consciousness. This study aimed to evaluate the discriminative ability of the prehospital qSOFA score for in-hospital mortality in patients with trauma.

METHODS:

This retrospective multicenter study used data from 42,722 patients with trauma included in a Japanese nationwide trauma registry. All included patients were aged ≥18 years old and transferred to hospitals from the scenes of injury. The primary outcome was in-hospital mortality.

RESULTS:

The included patients had a mean age of 59.4 ± 21.5 years and a male predominance (63%). In-hospital mortality occurred in 2612 patients (6%), while 2-day mortality occurred in 1189 of 42,339 patients (3%). When patients were stratified by qSOFA scores, in-hospital mortality rates of 0.9% (105/11783), 5% (941/17839), 12% (1280/11132) and 15% (286/1968) were associated with qSOFA scores of 0, 1, 2 and 3, respectively (P < 0.0001 for trend). The area under the receiver operating characteristics curve of the qSOFA score for in-hospital mortality was 0.70 (95% confidence interval: 0.69-0.71). A qSOFA score cutoff value ≥1 yielded a sensitivity and specificity of 0.96 and 0.29, respectively, overall, and a sensitivity of 0.99 in patients younger than 65 years.

CONCLUSIONS:

The prehospital qSOFA score was strongly associated with in-hospital mortality in patients with trauma. A prehospital qSOFA score cutoff of ≥1 can be used to identify patients at a very low risk of death, especially in younger age groups.

KEYWORDS:

In-hospital mortality; Prehospital; Quick sequential organ failure assessment score; Trauma; Triage

PMID:
30878407
DOI:
10.1016/j.ajem.2019.03.007

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