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An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

BACKGROUND: Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessi...

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Autor principal: Jiang, Xiaobin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PeerJ Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597630/
https://www.ncbi.nlm.nih.gov/pubmed/33194421
http://dx.doi.org/10.7717/peerj.10242
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author Jiang, Xiaobin
author_facet Jiang, Xiaobin
author_sort Jiang, Xiaobin
collection PubMed
description BACKGROUND: Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. METHOD: To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. RESULTS: We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. CONCLUSIONS: Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.
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spelling pubmed-75976302020-11-12 An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity Jiang, Xiaobin PeerJ Anesthesiology and Pain Management BACKGROUND: Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. METHOD: To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. RESULTS: We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. CONCLUSIONS: Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients. PeerJ Inc. 2020-10-27 /pmc/articles/PMC7597630/ /pubmed/33194421 http://dx.doi.org/10.7717/peerj.10242 Text en ©2020 Jiang https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.
spellingShingle Anesthesiology and Pain Management
Jiang, Xiaobin
An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
title An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
title_full An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
title_fullStr An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
title_full_unstemmed An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
title_short An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
title_sort improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity
topic Anesthesiology and Pain Management
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597630/
https://www.ncbi.nlm.nih.gov/pubmed/33194421
http://dx.doi.org/10.7717/peerj.10242
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