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. 2018 Nov 29;18(1):48.
doi: 10.1186/s12873-018-0203-4.

Predictive value of quick surgical airway assessment for trauma (qSAT) score for identifying trauma patients requiring surgical airway in emergency room

Kei Hayashida  1 , Shokei Matsumoto  2 , Mitsuhide Kitano  2 , Junichi Sasaki  3
Affiliations

Predictive value of quick surgical airway assessment for trauma (qSAT) score for identifying trauma patients requiring surgical airway in emergency room

Kei Hayashida et al. BMC Emerg Med. .

Abstract

Background: A surgical airway is usually unpredictable in trauma patients. The aim of this study was to develop a predictable scoring system to determine the need for a surgical airway by using a database from a large multicenter trauma registry.

Methods: We obtained data from the nationwide trauma registry in Japan for adult blunt trauma patients who were intubated in the emergency department. Based on a multivariate logistic regression analysis in the development cohort, the Quick Surgical Airway Assessment for Trauma (qSAT) score was defined to predict the need for a surgical airway. The association of the qSAT with surgical airway was validated in the validation cohort.

Results: Between 2004 and 2014, 17,036 trauma patients were eligible. In the development phase (n = 8129), the qSAT score was defined as the sum of the three binary components, including male sex, presence of a facial injury, and presence of a cervical area injury, for a total score ranging from 0 to 3. In the validation cohort (n = 8907), the proportion of patients with a surgical airway markedly increased with increasing qSAT score (0 points, 0.5%; 1 point, 0.9%; 2 points, 3.5%; 3 points, 25.0%; P < 0.001). Multivariate analysis revealed that qSAT score was an independent predictor of surgical airway (adjusted OR, 3.19 per 1 point increase; 95% CI, 2.47-4.12; P < 0.0001). The qSAT score of ≥1 had a had a good sensitivity of 86.8% for predicting the requirement for surgical airway; while qSAT score of 3 had a good specificity of 99.9% in ruling out the need for surgical airway.

Conclusions: The qSAT score could be assessed simply using only information present upon hospital arrival to identify patients who may need a surgical airway. The utilize of qSAT score in combination with repeated evaluations on physical finding could improve outcomes in trauma patients.

Keywords: Difficult airway; Emergency airway; Emergency room; Intubation; Prediction; Surgical airway; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the medical ethics committee of the Keio University Hospital and the requirement for informed patient consent was waived to ensure participant anonymity. We have provided information about the implementation of the trauma registry (JTDB) and the utilization of it for scientific researches by the website of our emergency department.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient selection. JTDB = Japanese Trauma Data Bank, ED = emergency department, AIS = Abbreviated Injury Scale
Fig. 2
Fig. 2
Association of qSAT scores with the probability for surgical airway management in the validation dataset
See this image and copyright information in PMC

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