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Trauma scoring system to

predict mortality rate in


emergency departement
Achmad Yani

Background
Trauma is a time-sensitive condition.
Especially during the first hour of
trauma management
Assessment, Resuscitation and
Definitive care are very important.
Providing definitive care earlier at
trauma centers has been shown to
decrease mortality

Why
TRAUMA
First one
Hour
assesment
Resucitation
Definitive
care

TRAUMA
CENTER

DEATH

When
Two situations that occur in trauma
patient care:
They can be used in the field, before
the patient reaches the hospital, to
decide whether to send the patient to
a trauma center.
Clinical decision making when the
trauma patient has just arrived at the
emergency department ED

Classification
Anatomic Score:
Organ Injury Scale
by American Association for the surgery of Trauma

Abbreviated Injury Scale(AIS)


Injury Severity Scale(ISS)
Physiologic Score
Revised Trauma Score (RTS
Triage RTS (T-RTS)
Mechanism, Glasgow Coma Scale, Age, and
ArterialPressure (MGAP)
Glasgow Coma Scale, Age, and Systolic Blood
Pressure(GAP)

Organ Injury Scale

Abbreviated Injury
Scale(AIS)

Injury Severity Scale(ISS)


6 body regions:
(1)head/neck(2)face(3)chest(4)abdomen /
pelvis content (5) (6)extremities
Maximum AIS for three regions
ISS=AIS12+AIS22+AIS32
Maximum ISS 75
Any AIS=6 result in ISS= 75

Injury Severity Score Range


1-75
If injury is assigned a 6
(unsurvivable), ISS
automatically = 75
Score Reflective of Injury Severity

1 - 9 Minor
10 - 15 Moderate
16 - 24 Moderate/Severe
25 Severe/Critical

Revised Trauma Score(RTS)

Calculating the RTS


AGE >14 YEARS OR BEST GUESS
REVISED TRAUMA
SCORE (RTS)

RESPIRATORY RATE
SYSTOLIC B/P
GCS

+4

+3

+2

+1

10-29

>29

6-9

<6

>89

76-89

50-75

<50

13-15

9-12

6-8

<6

1 +4 +1 = 6

PEDIATRIC TRAUMA SCORE (PTS)

Developed to reflect differences


between adult & child physiology
Diminished emphasis on blood pressure
Scores reflect size, airway patency,
and severity & multiplicity of obvious
wounds
Superiority over RTS is as yet unproven

Calculating the PTS

2 +2 +1 +1 -1 -1 = 4

Combination of Anatomic Score


and Physiologic Score
Trauma Score-Injury Severity
Score(TRISS)
Ps=1/(1+e-b)
b= b0+b1*RTS+b2*ISS+b3*Age
Index

Application
Objective description of injury
Help for decision making for clinician
Prediction of patient outcome
Evaluation the performance of care
center
Search for unexpected death

The Champion Trauma Triage Decision Scheme

M Me ea as su ur er e V Vi t iat al lS Si g i gn ns s a an nd d L LO OC C
G GC CS S < <1 13 3 o or r
S Sy sy st ot ol i cl i c B B/ P/ P < <9 90 0 o or r
R Re es sp pi r iar at ot or yr y R Ra at et e < <1 10 0 o or r> >2 29 9

Y Ye es s

N No o

T To o T Tr ar au um ma a C Ce en nt et er r

A As ss se es ss s A An na at ot om my y & & M Me ec ch ha an ni s i sm m o of fi n i nj u j ur yr y

The Champion Trauma Triage Decision Scheme


P Pe ne ne te r tar ta i nt i ng g I nI nj u j ur yr yt ot o C Ch he se ts, t ,A Ab bd do mo me en n, ,H He ea da d, ,N Ne ec kc ,k ,o ro rG Gr or ion i n? ?
2 2 o ro rM Mo ro er e P Pr or xo ixmi ma la Ll Lo no ng g B Bo no ne e F Fr ar ca tcut ur er se ?s ?
C Co mo mb bi n i na ta i ot i no n o fo Bf Bu ur nr ns s a na nd d T Tr ar ua um ma ?a ?
F Fl a l ai l i Cl Ch he es ts?t ?
F Fa lal l >l >2 20 0' o' or rC Cr ar as hs h S Sp pe ee ed d > >2 20 0m mp ph h o or r> >2 20 0" "D De feo f ro mr mi t yi t yo fo Vf Ve he hi c i lce l ?e ?
R Re ae ra wr wa ar dr d D Di s i ps pl a l ca ec me me en nt to fo fF Fr or no nt tA Ax lxe l ?e ?
E Ej e j ce tci ot i on n? ? R Ro lol ol l ov ev er ?r ? D De ae at ht h o of Of Ot ht he re rO Oc cc uc up pa na nt ?t ?
P Pe de de se tsr ti ra i an n h hi t i ta ta t> >2 20 0m mp ph h? ?

Y Ye es s

N No o

T To o T Tr ar ua um ma a C Ce ne nt et re r

A As ss es se ss sf o f ro rA Ag ge e a na nd d P PM MH H

The Champion Trauma Triage Decision Scheme

A Ag ge e < <5 5 o or r> >5 55 5? ?


K Kn no ow wn n C Ca ar dr di ai ac c o or rR Re es sp pi r iar at ot or yr y D Di s i se ea as se e? ?

Y Ye es s

NNo o

C Co on ns si di de er rT Tr ar au um ma a C Ce en nt et er r

C Co on nt at ac ct tM Me ed di c i ca al lC Co on nt r tor ol lf of or rA Ad dv vi c i ce e

" "WW h he en n i ni n D Do ou ub bt ,t ,C Co on nt at ac ct t MM e ed di ci ca al lC Co on nt rt or ol .l". "

Three Components of Trauma


Triage Assessment
Physiologic
Anatomic
Kinematic

MAINE EMS TRAUMA TRIAGE PROTOCOL


Determine:
Determine:
Glasgow
GlasgowComa
ComaScale
Scale
Systolic
Blood
Systolic BloodPressure
Pressure
Respiratory
RespiratoryRate
Rate

I. OLMC confirms RTS/PTS


I. OLMC confirms RTS/PTS
II. OLMC considers patient transport to
II. OLMC considers patient transport to

Calculate:
Calculate:
Revised
RevisedTrauma
TraumaScore
Score(RTS)
(RTS)
oror
Pediatric
PediatricTrauma
TraumaScore
Score(PTS)
(PTS)

Is RTS <11 or PTS <8?

YES

NO
Determine: if any of the following exist:
Paralysis;
Amputation proximal to wrist or ankle;
Penetrating injury to chest, abdomen, head or neck;
YES
Two or more proximal long bone fractures;
Unstable pelvic fracture;
Open or depressed skull fracture;
Burn associated with trauma

NO
Determine:
Determine:ififthere
thereisisassociated
associated
fatality
in
same
fatality in same
vehicle
vehiclecompartment
compartment

NO
TRANSPORT TO
TRAUMA SYSTEM
PARTICIPATING
HOSPITAL

YES

Trauma Center, using following guidelines:


Trauma Center, using following guidelines:
a) If transport time by ground or air to Trauma Center
a) If transport time by ground or air to Trauma Center
is less than 30 minutes, patient should go to Trauma
is less than 30 minutes, patient should go to Trauma
Center directly;
Center directly;
b) If transport time to Trauma Center is greater than
b) If transport time to Trauma Center is greater than
30 minutes, determine the difference in transport time
30 minutes, determine the difference in transport time
between the Trauma Center and the most accessible
between the Trauma Center and the most accessible
hospital:
hospital:
1) If difference is less than 10 minutes,
1) If difference is less than 10 minutes,
consider transport to Trauma Center;
consider transport to Trauma Center;
2) If difference is greater than 10 minutes,
2) If difference is greater than 10 minutes,
consider transport to most accessible
consider transport to most accessible
hospital;
hospital;
III. If, upon arrival in the ED,
III. If, upon arrival in the ED,
a) Facility is not a Trauma Center, and;
a) Facility is not a Trauma Center, and;
b) Patient continues to satisfy criteria of Assessments
b) Patient continues to satisfy criteria of Assessments
One and Two, and;
One and Two, and;
c) Patient can be stabilized for further transport, then
c) Patient can be stabilized for further transport, then
receiving ED clinician should provide only life-saving
receiving ED clinician should provide only life-saving
procedures (avoiding unnecessary diagnostics) prior
procedures (avoiding unnecessary diagnostics) prior
to transport to Trauma Center unless he/she judges
to transport to Trauma Center unless he/she judges
clinical situation to not warrant such transfer.
clinical situation to not warrant such transfer.

IfIfpre-hospital
pre-hospitalproviders
providersare
areunable
unabletotodefinitively
definitively
manage
the
airway,
maintain
breathing
manage the airway, maintain breathingor
or
support
circulation,
begin
transport
to
most
support circulation, begin transport to most
accessible hospital and simultaneously request
accessible hospital and simultaneously request
ALS
ALSintercept
interceptand
andOLMC.
OLMC.