AdHOC Score for a Trauma Patient with Major Fractures

Description

Knoepfel et al reported the AdHOC score for evaluating trauma patients with major fractures. This can help to identify a patient who may require more aggressive management. The authors are from University Hospital Zurich and University Witten/Herdecke Cologne.

AdHOC is an acronym for Age, Head injury, Oxygenation and Circulation

Patient selection: severe injury with major fractures AND age >= 16 years, ISS >= 9

Parameters:

(1) age in years

(2) head injury

(3) oxygenation

(4) circulation

Parameter	Finding	Points
age	<= 65 years	0
	> 65 years	1
head injury	GCS < 12	1
	pupil size not equal	1
	pupil reactivity not brisk	1
	motor function non-specific or none	1
	other	0
oxygenation	hemothorax present	1
	base excess <= -6 mmol/L	1
	PaO2/FIO2 <= 200	1
	other	0
circulation	admission systolic BP <= 90 mm Hg	1
	transfused packed RBCs	1
	INR > 1.4	1
	hemoglobin < 7 g/dL	1
	other	0

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0

• maximum score: 4

Score	Multi-Organ Failure	Mortality
0	5%	0.1 to 0.3%
1	19%	5%
2	39%	16%
3	62%	42%
4	76%	62%

where:

• The paper states that the score ranges from 0 to 4. In Figure 2 the range under Multi-Organ Failure is 1 to 5. Why is unclear. The text on page 419 (top, left column) suggests that the range for multi-organ failure should be 0 to 4.

Performance:

• The area under the ROC curve is 0.86 in the derivation and 0.88 in the validation cohorts.

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AdHOC Score for a Trauma Patient with Major Fractures

Description

Specialty