Morris et al reported 2 scores for predicting the risk of an older trauma patient. One version (fEMAT) is used after evaluation. The authors are from the University of Minnesota, Medical College of Wisconsin, and University of Michigan.
Patient selection: age >= 65 years
Parameters:
(1) bowel or pancreas injury
(2) traumatic brain injury
(3) great vessel injury
(4) cervical spine injury
(5) penetrating injury
(6) solid organ injury
(7) number of rib fractures
(8) hemo or pneumothorax
(9) femur fracture
(10) pelvic injury
(11) thoracic or lumbar spine injury
(12) advanced directive with do not resuscitate (DNR) in place
(13) cirrhosis
(14) chronic renal failure
(15) congestive heart failure
(16) chronic obstructive pulmonary disease
(17) stroke with residual neurologic deficits
(18) history of myocardial infarction within the past 6 months
(19) steroid use
(20) systolic blood pressure in mm Hg
(21) pulse in beats per minute
(22) Glasgow coma scale
(23) respiratory rate in breaths per minute
|
Parameter |
Finding |
Points |
|
bowel or pancreas injury |
no |
0 |
|
|
yes |
20 |
|
traumatic brain injury |
no |
0 |
|
|
yes |
15.5 |
|
great vessel injury |
no |
0 |
|
|
yes |
11.5 |
|
cervical spine injury |
no |
0 |
|
|
yes |
11 |
|
penetrating injury |
no |
0 |
|
|
yes |
10.5 |
|
solid organ injury |
no |
0 |
|
|
yes |
9.5 |
|
number of rib fractures |
0 |
0 |
|
|
1 to 6 |
1 |
|
|
>= 7 |
6 |
|
hemo/pneumoperitoneum |
no |
0 |
|
|
yes |
6 |
|
femur fracture |
no |
0 |
|
|
yes |
5 |
|
pelvic injury |
no |
0 |
|
|
yes |
4 |
|
thoracic or lumbar spine injury |
no |
0 |
|
|
yes |
1.5 |
|
DNR in place |
no |
0 |
|
|
yes |
23.5 |
|
cirrhosis |
no |
0 |
|
|
yes |
17 |
|
chronic renal failure |
no |
0 |
|
|
yes |
13 |
|
congestive heart failure |
no |
0 |
|
|
yes |
10 |
|
COPD |
no |
0 |
|
|
yes |
6 |
|
stroke with residua |
no |
0 |
|
|
yes |
4.5 |
|
history of AMI |
no |
0 |
|
|
yes |
4 |
|
steroid use |
no |
0 |
|
|
yes |
2.5 |
|
systolic blood pressure |
>= 110 mm Hg |
0 |
|
|
90 to 109 |
10 |
|
|
< 90 |
13.5 |
|
pulse |
> 120 |
11.5 |
|
|
50 to 120 |
0 |
|
|
< 50 |
7.5 |
|
Glasgow coma scale |
|
5 * (15 - GCS) |
|
respiratory rate |
> 29 |
2.5 |
|
|
9 to 29 |
0 |
|
|
< 9 |
2.5 |
total score for the parameters =
= SUM(points for all of the risk factors)
Interpretation:
• minimum score: 65
• maximum score for parameters: 271.5
• maximum score with age: 371.5
|
Score |
Probability of In-Hospital Morality |
|
65 |
0 |
|
66 to 195 |
X = (-0.000312 * ((score)^2)) + (0.13763 * (score)) - 13.579 probability = 1 / (1 + EXP((-1) * X)) |
|
> 195 |
> 81% |
Specialty: Surgery, orthopedic, Surgery, general, Emergency Medicine
