Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

Abstract

Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is.

Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves.

Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant.

Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.

Keywords: aortic injury; multiple injured; scoring systems; trauma.

Figure 1

Recruitment flow diagram. We found 70 patients within our hospital databank. Four had to be excluded due to miss-coding and one excluded due to incomplete data.

Figure 2

ROC curves for the (a) APACHE II, (b) NISS, (c) ISS, (d) ISS without aortic injuries, (e) RTSc and (f) TRISS. APACHE II—acute physiology and chronic health evaluation II; NISS—new injury severity score; ISS—injury severity score; RTSc—revised trauma score coded; TRISS—trauma and injury severity score.

Figure 2

ROC curves for the (a) APACHE II, (b) NISS, (c) ISS, (d) ISS without aortic injuries, (e) RTSc and (f) TRISS. APACHE II—acute physiology and chronic health evaluation II; NISS—new injury severity score; ISS—injury severity score; RTSc—revised trauma score coded; TRISS—trauma and injury severity score.