Article
Bleeding in Polytrauma – evaluation of the modified Trauma Induced Coagulopathy Clinical Score (mTICCS)
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Published: | October 22, 2019 |
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Objectives: Hemorrhage is one of the leading problems in polytraumatized patients and still a major cause of early death after trauma. Therefore, quick assessment of patients in need for aggressive fluid management is crucial and might improve survival. The mTICCS was found to be easy to use (3 main criteria, 9 sub-parameters). In this study we aimed to validate it against other established scores.
Methods: Comparison of 5 scoring systems (TASH, ABC, Larson, ETS and PWH) against mTICCS to evaluate the need for massive transfusion within the first 24 hours after admission. Severely injured patients with hospital admission between 2010 and 2015 were evaluated. For each score the area under the curve (AUC) of the receiver operating curve (ROC) was calculated. The Youden Index was used to determine the cut-off value that maximizes sensitivity and specificity simultaneously. Prevalence, sensitivity, specificity, positive predicted values (PPV) and negative predicted values (NPV) were given for the descriptive comparison of the diagnostic performance of scores. Pairwise comparisons of the AUCs of each score to mTICCS were performed using the method of DeLong et al. at a significance level of 5%. All analyses were performed by MedCalc®, version 18.9.1.
Results and conclusion: In total 479 patients were included. Mean age was 49 ±22 years and mean ISS was 25 ±8 points. Massive transfusion was recorded in 8.4%. It was found that the discrimination ability of mTICCS (AUC 0.776) showed no statistically significant difference to established scores (AUC TASH: 0.782, ABC: 0.684, Larson: 0.740, ETS: 0.713, all p>0.05) and was even superior to PWH-score (AUC PWH: 0.648, p=0.01). Cut off value for mass transfusion was >5 points rating in mTICCS, >8 in TASH, >0 in ABC, >1 in Larson, >2 in PWH and >2.5 in ETS.
In summary, the ability to discriminate against the need for aggressive fluid management of mTICCS is superior to PHW-score and comparable to established scores. Due to the simplicity of application, mTICCS can be used at very early stages in polytrauma management. However, prospective validations are needed to prove mTICCS as a useful scoring system for the future.