The role of test results in the emergency department in the evaluation of major torso injury patients

Abstract

We studied the role of laboratory tests in the emergency department (ED) for the prediction of outcomes in major torso injury patients. We hypothesized that the laboratory test results in the ED could predict worse outcomes and be complement of the TRISS (trauma and injury severity score) which serves a popular prediction model for trauma patients. Patients with major torso trauma who were sent to a level-I trauma center between January 2016 and December 2020 were retrospectively studied. Demographic information, TRISS, and laboratory data (glucose, lactate, base deficit (BD)) were collected and analyzed. The early death (death within 24 hours from the ED arrival) and the long intensive care unit (ICU) length of stay (LOS) (over seven days) were defined as the primary and secondary outcomes. A prediction model that integrated TRISS and the laboratory test results was created and evaluated by using the receiver operating characteristic (ROC) curve with the area under the curve (AUC). In total, 827 patients were studied. The glucose (255.2 ± 109.9 vs. 192.1 ± 77.0, p < 0.001) and lactate (77.2 ± 43.4 vs. 39.2 ± 26.4, p < 0.001) levels were significantly higher in patients who died early. The performance of glucose, lactate and BD in identifying those major torso trauma patients who would die early demonstrated acceptable discrimination (glucose: AUC = 0.687; lactate: AUC = 0.778; BD: AUC = 0.734). Furthermore, a model that integrated the TRISS and laboratory tests showed calibration of AUC = 0.863. Moreover, the levels of BD and glucose were also independent factors of long ICU LOS. In conclusion, checking lactate, BD and blood glucose is recommended in the evaluation of major torso trauma patients. Biochemical markers are beneficial in predicting worse outcomes for patients with major torso trauma and can complement the TRISS for these patients.