New index to predict the possibility of hemostatic angiographic embolization in trauma patients assessed by emergency medical services

Abstract

Trauma is an important public health issue and a leading cause of mortality worldwide. We developed a concise index that predicts the possibility of hemostatic angiographic embolization in trauma patients assessed by emergency medical services (EMS). Two Asia-Pacific countries were involved in this study: 13 emergency departments (EDs) in South Korea and 15 EDs in Malaysia. Patients with trauma transported by EMS between January 2015 and December 2018 were enrolled in this study. Hemostatic angiographic embolization was defined as the presence of at least one procedure performed within 24 h of the ED visit. A simple index was developed with key components after principal component analysis: scene shock index (SI) + ED SI-prehospital alertness. Prediction performance was evaluated by the area under the receiver operating characteristic curve (AUC) and was compared to the revised trauma score (RTS), age-adjusted shock index (AGE-SI), and surgical intervention in victims of motor vehicle crashes (SIM) score. A total of 28,772 patients were included in the final analysis. Overall, 657 patients (2.3%) underwent hemostatic angiographic embolization. Scene SI and ED SI were significantly different: median (q1–q3) was 0.63 (0.75–1.00), 0.69 (0.59–0.85) in patients who underwent hemostatic angiographic embolization and 0.55 (0.64–0.73), 0.61 (0.51–0.72) in patients who did not undergo hemostatic angiographic embolization. Prehospital alertness was observed in 192 (29.2%) and 19,978 (71.1%) patients with and without hemostatic angiographic embolization, respectively. Greater predictive performance for hemostatic angiographic embolization was observed (AUC: 0.792 for new index, 0.672 for SIM score, 0.562 for RTS, and 0.507 for AGE-SI). A new index showed higher predictive performance for hemostatic angiographic embolization in adult EMS-transported trauma patients compared to the SIM score, RTS, and AGE-SI.