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.
Specialty: Surgery, orthopedic, Emergency Medicine