Accuracy of early warning scores for predicting serious adverse events in pre-hospital traumatic injury

Abstract

Background: Traumatically injured patients are at higher risk of serious adverse events. Numerous physiological scoring systems are employed as diagnostic and/or prognostic tools. The objective of this study was to evaluate the scales most commonly used by emergency medical services for the early detection of prehospital serious adverse events.

Methods: Design. Preliminary longitudinal prospective observational study without intervention study in adults with prehospital traumatic injury.

Setting: The study was carried out in the public health system of Castile and León (Spain), from April 1, 2018 to October 31, 2019, involving seven advanced life support units and five hospitals.

Participants: Traumatically injured patients over 18 years of age who were stabilized and transferred in advanced life support units to their referral hospital.

Main outcome measures: Appearance of serious adverse events at the prehospital level at the scene or during the transfer to the emergency department.

Results: A total of 346 patients were included in the study. The median age was 50 years (IQR: 38-65). 32 cases (7.8%) presented serious adverse events at the prehospital level. Areas under the curve for the detection of serious adverse events were obtained with the Prehospital Index (0.979; 95% CI: 0.94-1.00) and National Early Warning Score 2 (0.956; 95% CI: 0.90-1.00); p <0.001 for all scores. The Prehospital Index had a positive probability coefficient of 78.4 (95% CI: 62.8-68.6) and the National Early Warning Score 2 obtained 52.9 (95% CI: 39.7-65.6). A comparison of the curves was not significant for any of the scores studied (p> 0.05).

Conclusions: All scoring systems were able to detect prehospital serious adverse events early in traumatic injury; therefore, any of the scoring systems could be useful and represent an ideal tool for routine use by emergency medical services in cases of traumatic injury.

Keywords: Clinical decision; Emergency medical services; Patient safety; Pre-hospital care; Risk prediction score; Serious adverse events; Trauma.