Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outc...

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Autores principales:	Alexander Omar, Marcel Winkelmann, Emmanouil Liodakis, Jan-Dierk Clausen, Tilman Graulich, Mohamed Omar, Christian Krettek, Christian Macke
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	trauma aortic injury scoring systems multiple injured Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/e2c26e8f617e4a53abe9ea66638c4a6a
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spelling	oai:doaj.org-article:e2c26e8f617e4a53abe9ea66638c4a6a2021-11-25T17:22:07ZApplicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries10.3390/diagnostics111121562075-4418https://doaj.org/article/e2c26e8f617e4a53abe9ea66638c4a6a2021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/2156https://doaj.org/toc/2075-4418Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.Alexander OmarMarcel WinkelmannEmmanouil LiodakisJan-Dierk ClausenTilman GraulichMohamed OmarChristian KrettekChristian MackeMDPI AGarticletraumaaortic injuryscoring systemsmultiple injuredMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 2156, p 2156 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	trauma aortic injury scoring systems multiple injured Medicine (General) R5-920
spellingShingle	trauma aortic injury scoring systems multiple injured Medicine (General) R5-920 Alexander Omar Marcel Winkelmann Emmanouil Liodakis Jan-Dierk Clausen Tilman Graulich Mohamed Omar Christian Krettek Christian Macke Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
description	Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.
format	article
author	Alexander Omar Marcel Winkelmann Emmanouil Liodakis Jan-Dierk Clausen Tilman Graulich Mohamed Omar Christian Krettek Christian Macke
author_facet	Alexander Omar Marcel Winkelmann Emmanouil Liodakis Jan-Dierk Clausen Tilman Graulich Mohamed Omar Christian Krettek Christian Macke
author_sort	Alexander Omar
title	Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
title_short	Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
title_full	Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
title_fullStr	Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
title_full_unstemmed	Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries
title_sort	applicability of anatomic and physiologic scoring systems for the prediction of outcome in polytraumatized patients with blunt aortic injuries
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/e2c26e8f617e4a53abe9ea66638c4a6a
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Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

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