ABSTRACT
Objective To study the utility and feasibility of CRAMS score to assess prognosis of patients with acute trauma.Methods A retrospective review of 1 802 patients with acute trauma was conducted to calculate CRAMS and ISS score.Receiver operation characteristic curve (ROC) was used to measure the prognostic role of CRAMS in comparison with ISS.Results Area under the curve (RUC) was 0.885 for CRAMS (95 ％ CI 0.870-0.900) and was 0.792 for ISS (95％ CI 0.773-0.811),with statistical difference of the two scoring systems (Z=4.280,P ＜0.01).To identify patients with potential critical illness,optimal cut-off point was≤7 for CRAMS and≥24 for ISS.CRAMS presented better sensitivity (x2 =16.910,P ＜ 0.01),but lower specificity (x2 =5.260,P ＜ 0.05) and accuracy (x2 =0.693,P ＞ 0.05) for predicting mortality when compared with ISS.Conclusions CRAMS is better than ISS in predicting prognosis for patients with acute trauma and exhibits a high discrimination.RAMS has advantages of simple operation,easy grasping and accurate and timely reflection of illness severity,which facilitates the early detection and treatment of critical illness in inhospital trauma patients.
ABSTRACT
Objective To evaluate the application value of prehospital index (PHI) in hospitalized patients with acute trauma.Methods A study was done in 1802 hospitalized patients with acute trauma by random sampling.PHI and injury severity score (ISS) were made respectively.Receiver operating characteristic curve (ROC curve) was used for detecting optimal cut-off point by taking the date of discharge as the endpoint and the outcome as observed indicator.In order to compare the predicting prognosis value of PHI in hospitalized patients with acute trauma,the corresponding predicting indicators were calculated and ISS was used for reference.Results The area under the ROC curve was 0.871 (95％ CI:0.855-0.886) by the score of PHI and 0.792 (95％ CI:0.773-0.811) by the score of ISS,and there was statistically difference between the two scoring systems (Z =2.674,P =0.007),and the optimal cut-off point was used for judging the potential for critically ill patients when PHI was ≥ 4,ISS ≥ 22.The sensitivity predictors of critically ill patients death of PHI was superior to ISS (x2 =6.975,P =0.008),the specificity and the accuracy of PHI and ISS showed no significant difference (P ＞ 0.05).Conclusions PHI has high potential for assessing patient condition and predicting the death of hospitalized patients with acute trauma,and it is equivalent to ISS in prediction value.The advantages of PHI are simple in operation,easy to learn,reflecting the condition timely and reliably,suitable for dynamic evaluation and comparison,which is suitable for critical patients with trauma of preliminary screening.