31 - Freie Mitteilung
15. Mai 2019, 15:30 - 17:00, Szenario 1, 5. OG
Testing the (M)GAP in a Swiss trauma centre: An emergency score useful to forecast mortality, but limited in predicting the need for essential centre resources
P. Braken1, M. Zeindler1, F. Amsler2, T. Gross1, Presenter: P. Braken1 (1Aarau, 2Basel)
By using the modified emergency room (ER) trauma team activation (TTA) criteria of the TraumaNetwork DGU® we demonstrated possible over- and undertriage rates as recommended by the American College of Surgeons. Since non-adherence to the extensive triage criteria list was a major reason for observed undertriage, we tested the precision of two more simple preclinical triage tools (M)GAP ((Mechanism), Glasgow Coma Scale (GCS), Age and Systolic Blood Pressure) for resulting over- and undertriage with regard to several outcome parameters
Retrospective analysis of consecutively registered adult ER trauma patients, treated in a Swiss trauma centre from 2013-2017. All cases were analysed regarding subsequent over- and undertriage when using the (M)GAP in comparison to proposed TraumaNetwork ERTTA criteria as to identify patients with an Injury Severity Score (ISS) >15, need for trauma centre resources and hospital mortality.
2130 injured received ER treatment. A calculation of the (M)GAP was possible in 2112 cases. 24% had an ISS>15, 34% were treated in the intensive care unit (ICU), 21 % needed intubation, 13% underwent emergency surgery and 181 patients (8.5%) died in the hospital. Regarding mortality, the use of (M)GAP would have missed one patient (undertriage 0.6%), whereas 766/2112 patients (overtriage 42%) would be unnecessarily treated in the ER. With respect to the ER selection criterion ISS>15 or need of trauma centre resources (ICU, emergency surgery, intubation) the (M)GAP showed over- and undertriage rates ranging between 32-39% and 18-32%, respectively. In comparison, the proposed ERTAA criteria predicted mortality with an under- and overtriage of 1.7% and 69%. For the ER selection criterion ISS>15 or need of trauma centre resources under- and overtriage ranged between 2-9% and 61-65%, respectively.
This Swiss trauma centre investigation confirmed the precision of the (M)GAP tools in the prediction of hospital mortality for ER trauma patients. Even though, in the preclinical decision process for trauma centre need, their clinical benefit demonstrated to be inferior to proposed ERTAA criteria, due to unacceptably high undertriage rates for patients with potential severe injury and need for subsequent therapy. Therefore, more extensive ERTAA cannot be substituted by simpler scores such as the (M)GAP.