Validation of a Visual-Based Analytics Tool for Outcome Prediction in Polytrauma Patients (WATSON Trauma Pathway Explorer) and Comparison with the Predictive Values of TRISS.

Cédric Niggli,Philipp Niggli,Hans-Christoph Pape,Ladislav Mica

doi:10.3390/jcm10102115

Cédric Niggli, Philipp Niggli + Show 2 more

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https://doi.org/10.3390/jcm10102115

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Abstract

Introduction: Big data-based artificial intelligence (AI) has become increasingly important in medicine and may be helpful in the future to predict diseases and outcomes. For severely injured patients, a new analytics tool has recently been developed (WATSON Trauma Pathway Explorer) to assess individual risk profiles early after trauma. We performed a validation of this tool and a comparison with the Trauma and Injury Severity Score (TRISS), an established trauma survival estimation score. Methods: Prospective data collection, level I trauma centre, 1 January 2018–31 December 2019. Inclusion criteria: Primary admission for trauma, injury severity score (ISS) ≥ 16, age ≥ 16. Parameters: Age, ISS, temperature, presence of head injury by the Glasgow Coma Scale (GCS). Outcomes: SIRS and sepsis within 21 days and early death within 72 h after hospitalisation. Statistics: Area under the receiver operating characteristic (ROC) curve for predictive quality, calibration plots for graphical goodness of fit, Brier score for overall performance of WATSON and TRISS. Results: Between 2018 and 2019, 107 patients were included (33 female, 74 male; mean age 48.3 ± 19.7; mean temperature 35.9 ± 1.3; median ISS 30, IQR 23–36). The area under the curve (AUC) is 0.77 (95% CI 0.68–0.85) for SIRS and 0.71 (95% CI 0.58–0.83) for sepsis. WATSON and TRISS showed similar AUCs to predict early death (AUC 0.90, 95% CI 0.79–0.99 vs. AUC 0.88, 95% CI 0.77–0.97; p = 0.75). The goodness of fit of WATSON (X2 = 8.19, Hosmer–Lemeshow p = 0.42) was superior to that of TRISS (X2 = 31.93, Hosmer–Lemeshow p < 0.05), as was the overall performance based on Brier score (0.06 vs. 0.11 points). Discussion: The validation supports previous reports in terms of feasibility of the WATSON Trauma Pathway Explorer and emphasises its relevance to predict SIRS, sepsis, and early death when compared with the TRISS method.

Highlights

Large patient databases have been successfully used to assess the clinical course in trauma patients [1,2,3]
The range of the injury severity score (ISS) score in the 107 polytrauma patients varied from ISS 17 to ISS 75
Trauma surgeons assert that the primary goal of trauma care to improve survival rates

Summary

Introduction

Large patient databases have been successfully used to assess the clinical course in trauma patients [1,2,3]. In line with these changes and medical improvements, the focus regarding complications has moved from early pulmonary changes to later complications that may determine outcomes, such as sepsis. It has become evident that an existing database can be used to select certain parameters that help determine certain risk profiles They reconfirm that a combination of indicators of acute haemorrhage, coagulopathy, acid–base changes, and indirect signs of soft tissue injury remain evident [1]. In the current follow-up study, we used a validation set of patients and compared the prognostic accuracy of the WATSON

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