1. May 2014 Paul Jones, MD MacTraumatic: Predicting Early Death in Trauma Patients

2. OBJECTIVE Does the simplified prognostic model developed by Perel et al. using Age, SBP and GCS accurately predict early death in HHS Trauma Registry patients?

3. Fig 4 Chart to predict death in trauma patients*. Perel P et al. BMJ 2012;345:bmj.e5166 ©2012 by British Medical Journal Publishing Group * Excludes Middle and Low income countries

4. METHODS MY INCLUSION CRITIERA –Age > 15 years old <82 –SBP < 90 mm Hg –HR > 110 –Or both

5. METHODS Search HHS Trauma Registry between January 1, 2009 and March 31, 2013 Total Trauma Registry Patients = 2871 –Meeting Inclusion Criteria: Total n = 246

6. METHODS PREDICTORS: –Age –Systolic Blood Pressure (SBP) –Glasgow Coma Scale (GCS) OUTCOME: –Early Mortality Observed Risk of Death Predicted Risk of Death

7. Baseline characteristics 1. = 15% mortality 2.TARN = 12% mortality 3. HHS = 13% morality

8. RESULTS

10. Fig 5 Internal and external calibration of simple chart. Perel P et al. BMJ 2012;345:bmj.e5166 ©2012 by British Medical Journal Publishing Group

11. Conclusions The simplified model accurately predicts early death in the HHS Trauma Registry. There was strong agreement between the predicted risk of death and the observed deaths in the HHS Trauma Registry.

12. References 1. Perel P, Prieto-Merino D, Shakur H, Clayton T, Lecky F, Bouamra O, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ 2012;345:e5166. 2. Moons, Karel G. M. ; Royston, Patrick ; Vergouwe, Yvonne ; et al. Prognosis and prognostic research: what, why, and how? BMJ. 2009 Feb 23;338:b375. doi: 10.1136/bmj.b375 3. Royston P, Moons KGM, Altman DG, Vergouwe Y. Prognosis and prognostic research: developing a prognostic model. BMJ 2009;338:b604 4. Altman DG, Vergouwe Y, Royston P, Moons KG. Prognosis and prognostic research: validating a prognostic model. BMJ. 2009 May 28;338:b605. doi: 10.1136/bmj.b605.

13. Thank You Erich Hanel Angela Coates Kristen O’Brien David Prieto-Merino

15. BACKGROUND A large randomized placebo controlled trial among trauma patients with, or at risk of, significant haemorrhage, of the effects of antifibrinolytic treatment on death and transfusion requirement Double blind RCT, London School of Hygiene and Tropical Medicine 274 Hospitals, 40 Countries, 20 211 adult trauma patients

16. BACKGROUND Perel et al. developed and validated a prognostic model to predict early death in patients with traumatic bleeding 1. Initially they developed a prognostic model development with 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury in CRASH-2 trial. They then externally validated their prognostic model with 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN) in the UK.

17. Systolic blood pressure < 90 mm Hg or heart rate >110 beats per min or both or who were considered to be at risk of significant hemorrhage and who were within 8 hours of injury. CRASH-2 INCLUSIONS