Application of ISS and CRAMS score for the assessment of the prognosis of patients with multiple trauma / 中华急诊医学杂志

ABSTRACT

Objective To compare the clinical value of injury severity score (ISS) and CRAMS (circulation,respiration,abdomen,motor,speech) score in the prognosis of patients with severe multiple trauma in emergency department.Methods A total of 93 severe multiple trauma patients with 69 male and 24 female and age ranged from 21 to78 years with mean age (43.4 ± 14) years admitted in the emergency department from March 2014 to December 2015 were enrolled into this study.All of them were evaluated by using ISS and CRAMS score respectively and their survival during hospitalization was observed.Then,the predictive capabilities of ISS and CRAMS score for the mortality of patients were assessed by using receiver operator characteristic (ROC) curves.Results The mean ISS was (25.59 ± 5.37) and mean CRAMS score was (6.75 ± 1.26) in 93 patients with severe multiple trauma.Compared with the survival group (n =75),the ISS in the death group (n =18) was significantly higher (t =7.13,P ＜0.01) and CRAMS score was significantly lower (t =-6.03,P ＜0.01).In the ROC curve analysis,the AUCROC of predicting mortality of multiple trauma patients by ISS score was 0.897 and CRAMS score was 0.891,respectively.There was no significant difference in accuracy of predicting mortality between the two scoring systems (Z =0.718,P ＞ 0.05).When the death was chosen as the prediction target,the optimal cut-off point for ISS was 27 and CRAMS score was 6,respectively.Conclusions CRAMS score in comparison with ISS score has the likewise predictive value for the prognosis of severe multiple trauma patients in emergency department.However,the CRAMS score is simple and easy in practice.The changes of CRAMS score demonstrate the severity of trauma timely and reliably,which is in favor of the diagnosis and treatment of hospitalized trauma patients in early stage.