Evaluation of the sequential organ failure assessment score and newly introduced criteria - Traumasis - in traffic collision patients

Abstract

Background: The aim of this study was to evaluate the performance of the Sequential Organ Failure Assessment (SOFA) score and the newly introduced criteria, traumasis, defined as a SOFA score 2 or more among trauma patients.

Methods: Consecutive adult traffic collision patients who were admitted to the study hospital emergency department (ED) from January 2017 to December 2018 were enrolled retrospectively in the study. The primary outcome was in-hospital death. The SOFA score was calculated using relevant initial ED data. Traditional risk scores for trauma patients, such as the injury severity score (ISS), the revised trauma score (RTS), and the trauma injury severity score (TRISS), were also calculated.

Results: A total of 927 patients were available for analysis, of whom 46 died (5.0%). The median SOFA score was 1.0 (interquartile range [IQR], 0.0-3.0). A total of 417 patients (45.0%) were identified as having traumasis (SOFA score ≥ 2), of whom 44 died (10.6%). The area under the receiver operating characteristic (AUROC) curve of the SOFA score (0.91; 95% confidence interval [CI] 0.87-0.95) was comparable with that of the TRISS (0.88; 95% CI, 0.84-0.93) and better than that of the ISS(0.81; 95% CI 0.75-0.86) and the RTS (0.82; 95% CI 0.75-0.90). The sensitivity, specificity, positive predictive value and negative predictive value of the traumasis criteria for the primary outcome were 95.7%, 63.0%, 11.9%, and 99.6%, respectively. The net reclassification improvement for the comparison between the traumasis criteria and major trauma criteria (ISS ≥ 15) was 0.69 (95% CI, 0.55-0.82; p < 0.001). The multivariate Cox regression model showed that the SOFA score (adjusted hazard ratio [aHR] 1.52; 95% CI 1.37-1.67) and traumasis (aHR 11.40; 95% CI 2.70-48.13), respectively, was independently associated with higher in-hospital mortality.

Conclusion: The SOFA score can be used as a reliable tool for predicting in-hospital death among traffic collision patients. The newly introduced criteria, traumasis, may be used as a risk-stratification and quality-control criteria among patients with trauma, similar to the sepsis criteria among patients with infectious disease.

Keywords: Emergency department based injury in-depth surveillance; SOFA; Traffic collision; Trauma; Traumasis; sepsis.