Servia et al reported the RETRASCORE to predict mortality for a trauma patient in the intensive care unit. This can help to identify a patient who may require more aggressive management. The authors are from the Spanish Society of Intensive Care Medicine and the data was based on the Spanish Trauma ICU Registry (RETRAUCI).
Patient selection: trauma patient in the ICU
Parameters:
(1) age in years
(2) prior treatment with antiplatelet agent or anticoagulation
(3) pre-hospital intubation
(4) high-risk mechanism (pedestrian crash, suicidal fall > 2 meters), gunshot, accidental fall < 2 meters, unknown)
(5) pupillary response to light
(6) Glasgow coma scale (GCS)
(7) MAIS for head
(8) MAIS for thorax
(9) hemodynamic failure
(10) respiratory failure
(11) coagulopathy
(12) mechanical ventilation
(13) massive hemorrhage
|
Parameter |
Finding |
Points |
|
age in years |
< 50 years |
0 |
|
|
50 to 64.99 years |
1 |
|
|
65 to 75 years |
2 |
|
|
> 75 years |
4 |
|
antiplatelet or anticoagulation |
no |
0 |
|
|
yes |
1 |
|
pre-hospital intubation |
no |
0 |
|
|
yes |
1 |
|
high-risk mechanism |
no |
0 |
|
|
yes |
1 |
|
pupils |
normal |
0 |
|
|
unilateral mydriasis |
2 |
|
|
bilateral mydriasis |
6 |
|
GCS |
9 to 15 |
0 |
|
|
3 to 8 |
2 |
|
MAIS head |
< 3 |
0 |
|
|
>= 3 |
2 |
|
MAIS thorax |
< 3 |
0 |
|
|
>= 3 |
-1 |
|
hemodynamic failure |
no |
0 |
|
|
yes |
2 |
|
respiratory failure |
no |
0 |
|
|
yes |
1 |
|
coagulopathy |
no |
0 |
|
|
yes |
1 |
|
coagulopathy |
no |
0 |
|
|
yes |
1 |
|
mechanical ventilation |
no |
0 |
|
|
yes |
1 |
|
massive hemorrhage |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -1
• maximum score: 22
|
Total Score |
Risk Group |
Mortality Rate |
|
-1 to 4 |
very low |
< 5% |
|
5 or 6 |
low |
10 to 15% |
|
7 or 8 |
medium |
20-30% |
|
9, 10, 11 |
high |
40-60% |
|
12 or 13 |
very high |
70 to 80% |
|
14 to 22 |
extreme |
> 85% |
Performance:
• The area under the ROC curve is 0.91.
Specialty: Pulmonology, Critical Care
