Total Glasgow Coma Scale Score Research Articles

Epidemiologic Pattern and Injury Mechanism of Intimate Partner Violence–Related Ocular Trauma in the US

Intimate partner violence (IPV) is an important cause of death and disability worldwide. The literature estimates that 45% of IPV injuries involve the eyes. Many medical fields have increased IPV-related research; however, ophthalmology IPV research remains rare. To evaluate the epidemiologic pattern and injury mechanism of IPV related to ocular trauma. This study was a retrospective cross-sectional analysis with deidentified data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes from the National Trauma Data Bank (NTDB), which is a data set collected by the American College of Surgeons. The NTDB is the largest US hospitalized trauma case database with submissions from more than 900 US facilities. Included in this analysis were the IPV-related ocular injuries of patients hospitalized between 2017 and 2019. Study data were analyzed from April 20 to October 15, 2022. IPV-related ocular injuries. Ocular injuries and adult IPV trauma survivors were identified with the ICD-10-CM codes. The following demographic data were collected: sex, age, race and ethnicity, health insurance plan, substance misuse screening results, trauma level of hospital, the emergency department disposition, the total Glasgow Coma Scale score, the abbreviated injury scale, and caregiver at discharge. A total of 2598 of the recorded ocular injuries were associated with IPV. Patients had a mean (SD) age of 45.2 (18.4) years, and 1618 were female (62.3%). Most patients in the population sample (1195 [46.0%]) were aged 18 to 39 years. The race and ethnicity distribution was as follows: 629 Black (24.2%), 296 Hispanic (11.4%), 1358 White (52.3%), 229 other (8.8%), and 86 missing (3.3%). Insurance statuses were Medicaid (847 [32.6%]), Medicare (524 [20.2%]), private insurance (524 [20.2%]), and self-pay (488 [18.8%]). Women had greater odds of testing positive during alcohol screening (odds ratio [OR], 1.42; 95% CI, 1.21-1.67; P < .001). Black patients were most likely to have Medicaid (OR, 1.64; 95% CI, 1.35-1.99; P < .001), Hispanic patients were most likely to self-pay (OR, 1.96, 95% CI, 1.48-2.58; P < .001), and White patients were most likely to use Medicare (OR, 2.94, 95% CI, 2.33-3.73; P < .001). Social determinants of health were identified as key risk factors for IPV-related ocular injuries. Study findings highlight identifiable risk factors associated with IPV and ocular trauma that can contribute to IPV awareness among ophthalmologists.

The First Report of Chryseobacterium gleum Caused Ventriculoperitoneal-shunt Infection in a Child.

To The Editors: Ventriculoperitoneal (VP) shunt is one of the most widely used and effective methods in the treatment of hydrocephalus in childhood. VP shunt infections have been observed in approximately 3.2%–25%, and Chryseobacterium spp. is a rare cause of VP shunt infections.1,2 Herein, we report the first VP shunt infection caused by Chryseobacterium gleum. A 12-month-old female (corrected age 8 months) born via spontaneous vaginal delivery, weighed 700 g at 25 weeks of gestation, was admitted to our emergency department with a fever with a maximum peak temperature of 39°C, projectile vomiting, and decreased oral intake. Her history included long-term ventilation in the neonatal intensive care unit with a diagnosis of moderate bronchopulmonary dysplasia. At 4 months of age, she developed intraventricular hemorrhage and progressive hydrocephalus, and a VP shunt was inserted. She had several episodes of VP shunt infections caused by S. epidermidis and S. aureus. At admission, the patient was febrile, tachycardic (heart rate, 160/min) and tachypneic (respiratory rate of 48/min). Physical examination showed weakness, lethargy and sleepiness. Her total Glasgow Coma Scale score was 12 (E3V4M5). Laboratory tests were as follows: white blood cell (WBC) count: 12.5 × 103/μL (neutrophil 37% and lymphocyte 54%), C-reactive protein: 20 mg/L, procalcitonin: 0.09 μg/L. The cerebrospinal fluid (CSF) WBC count was 120/mm3, protein 107 mg/dL and glucose 42 mg/dL. With the preliminary diagnoses of sepsis and shunt infection, intravenous (IV) cefotaxime (300 mg/kg/day) and IV vancomycin (60 mg/kg/day) was initiated empirically. Peripheral/catheter blood cultures and CSF samples were inoculated into aerobic and anaerobic culture bottles (BacT/ALERT, BioMérieux, Durham, USA). The patient underwent VP shunt externalization. The blood and urine cultures were negative during the patient’s follow-up. Chryseobacterium gleum was isolated in the CSF, shunt and ventricular catheter tip cultures on the 3rd day of treatment. The organism had high-level minimum inhibitory concentration (MIC) levels for meropenem (MIC = 32 μg/mL), imipenem (MIC = 32 μg/mL) and piperacillin-tazobactam (MIC = 250 μg/mL). MIC level of ciprofloxacin was 0.125 μg/mL and trimethoprim-sulfamethoxazole was 0.5 μg/mL. Cefotaxime and vancomycin were switched to IV trimethoprim/sulphamethoxazole (5 mg/kg every 6 hours) and ciprofloxacin (10 mg/kg every 8 hours). On the 5th day of the combined therapy, the patient’s CSF sample was evaluated and showed a WBC count of 30/mm3, glucose 42 mg/dL and protein 360 mg/ dL, and the CSF culture was sterile. Antibiotics were continued for 21 days. The patient was clinically stable, and no adverse effects or seizures were observed during or after the treatment. The extra ventricular drainage was removed, the VP shunt was inserted following 2 consecutive negative CSF cultures, and the patient was discharged. Chryseobacterium species are common in nature but are not found in human flora. Most cases are nosocomial and are frequently associated with immunosuppression or implantable devices. Chryseobacterum gleum is typically a low-virulence organism that can cause serious infections. It has been reported that Chryseobacterum gleum can cause infections such as central-line-associated bloodstream infection, community-acquired pneumonia and urinary tract infection in adults.3–5 Unlike previous reports, Chryseobacterium was isolated in the cerebrospinal fluid in our study. Chryseobacterum gleum commonly colonizes mechanical devices, causing device-associated infections, and can form biofilm. According to this study, VP shunt may be a risk factor for Chryseobacterium gleum infections. This report emphasizes the significance of Chryseobacterium species as a causative agent of a wide range of infections, and VP shunts can pose a risk for this agent. Data on the management of Chryseobacterium is limited. Antimicrobial susceptibility testing guidelines for Chryseobacterium infections should be developed for more effective and accurate treatment.

Influence of High-Frequency Repetitive Transcranial Magnetic Stimulation on Neurobehavioral and Electrophysiology in Patients with Disorders of Consciousness.

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has been proposed as a promising therapeutic intervention for patients with disorders of consciousness (DOC). However, its therapeutic effects in the literature are inconsistently documented. The primary aim of this study was to explore the alterations in neural connectivity and neurobehavioral reactivity during rTMS modulation in patients with DOC. In addition, safety was investigated as a secondary aim. The presence of bilateral N20 components in DOC patients was determined by somatosensory-evoked potential (SEP) before enrollment in the study. A total of 64 patients were enrolled and randomly placed into the active and sham groups. Ultimately, 50 patients completed the study. Twenty-five patients in the active group underwent real HF-rTMS, and 25 patients in the sham group underwent sham HF-rTMS, which was delivered over the left dorsolateral prefrontal cortex (DLPFC). The outcome measures of performed pre- and postintervention included the latencies of the N20 and N20-P25 amplitudes of SEP, brainstem auditory-evoked potential (BAEP) grade, JFK Coma Recovery Scale-Revised (CRS-R) score, and Glasgow Coma Scale (GCS) score; any adverse events were recorded at any time during the intervention. Following six weeks of treatment, a significant increase was observed in the total CRS-R and GCS scores, and the N20-P25 amplitudes of patients in the two groups were compared with that obtained from preintervention (all p values < 0.05). The waves of BAEP in the two groups also showed a trend toward normalized activity compared with preintervention grades (p values < 0.05). A significant decrease in the latencies of N20 (p values < 0.001) was observed in the active group compared with measurements obtained from preintervention, whereas no significant decrease was observed in the sham group (p values = 0.013). The improvement in total CRS-R scores (p values = 0.002), total GCS scores (p values = 0.023), and N20-P25 amplitudes (p values = 0.011) as well as the decrease in latencies of N20 (p values = 0.018) and change in BAEP grades (p values = 0.013) were significantly different between the two groups. The parameters in neural connectivity (N20-P25 amplitudes, N20 latencies, and BAEP grades) were significantly correlated with the total CRS-R and GCS scores at postintervention, and the changes of CRS-R before and after interventions have a positive relationship with N20-P25 amplitudes. No adverse events related to the rTMS protocol were recorded. Neural connectivity levels are affected by HF-rTMS and are significantly related to clinical responses in DOC patients with the presence of bilateral N20. The elevation of neural connectivity levels may lay a foundation for successful HF-rTMS treatment for DOC patients.

Late Awakening Is Common in Settings Without Withdrawal of Life-Sustaining Therapy in Out-of-Hospital Cardiac Arrest Survivors Who Undergo Targeted Temperature Management.

We investigated awakening time and characteristics of awakening compared nonawakening and factors contributing to poor neurologic outcomes in out-of-hospital cardiac arrest survivors in no withdrawal of life-sustaining therapy settings. Retrospective analysis of the Korean Hypothermia Network Pro registry. Multicenter ICU. Adult (≥ 18 yr) comatose out-of-hospital cardiac arrest survivors who underwent targeted temperature management at 33-36°C between October 2015 and December 2018. None. We measured the time from the end of rewarming to awakening, defined as a total Glasgow Coma Scale score greater than or equal to 9 or Glasgow Coma Scale motor score equals to 6. The primary outcome was awakening time. The secondary outcome was 6-month neurologic outcomes (poor outcome: Cerebral Performance Category 3-5). Among 1,145 out-of-hospital cardiac arrest survivors, 477 patients (41.7%) regained consciousness 30 hours (6-71 hr) later, and 116 patients (24.3%) awakened late (72 hr after the end of rewarming). Young age, witnessed arrest, shockable rhythm, cardiac etiology, shorter time to return of spontaneous circulation, lower serum lactate level, absence of seizures, and multisedative requirement were associated with awakening. Of the 477 who woke up, 74 (15.5%) had poor neurologic outcomes. Older age, liver cirrhosis, nonshockable rhythm, noncardiac etiology, a higher Sequential Organ Failure Assessment score, and higher serum lactate levels were associated with poor neurologic outcomes. Late awakeners were more common in the poor than in the good neurologic outcome group (38/74 [51.4%] vs 78/403 [19.4%]; p < 0.001). The awakening time (odds ratio, 1.005; 95% CIs, 1.003-1.008) and late awakening (odds ratio, 3.194; 95% CIs, 1.776-5.746) were independently associated with poor neurologic outcomes. Late awakening after out-of-hospital cardiac arrest was common in no withdrawal of life-sustaining therapy settings and the probability of awakening decreased over time.

The Majority of Major Amputations After Resuscitative Endovascular Balloon Occlusion of the Aorta Are Associated With Preadmission Trauma

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially lifesaving intervention. However, recent reports of associations with limb loss and mortality have called its safety into question. We aimed to evaluate patient and hospital characteristics associated with major amputation and inpatient mortality in patients undergoing REBOA for major trauma. The National Trauma Data Bank (2015-2017) was queried for patients who presented to trauma centers and were treated with REBOA. We included REBOAs performed on hospital day 1 in patients who survived at least 6 hours from presentation. Univariable and multivariable analyses were performed to evaluate associations with major amputation and in-hospital mortality. A total of 316 patients underwent REBOA and survived in the acute period after presentation. Overall, mean age was 45 ± 20 years, and the majority were men (73%) and white (56%). Most patients presented to level I trauma centers (72%) after blunt injuries (79%) with an average Injury Severity Score of 31 ± 15. In 15 patients (5%), there were 18 major amputations, 7 above knee (39%) and 11 below knee (61%). Eleven of the amputations (61%) were either traumatic amputations (73%) or mangled limbs requiring amputation within 24 hours (27%). Of the remaining amputations, 71% were associated with ipsilateral vascular or orthopedic lower extremity (LE) injuries of serious to severe Abbreviated Injury Scale. Comparison of patients with and without major amputations revealed no significant differences in patients’ demographics or chronic comorbidities or hospital characteristics. Patients undergoing major amputation were more likely to present with LE vascular injuries (33% vs 9%; P = .01) and LE Abbreviated Injury Scale severe vascular injuries (6.7% vs 1.3%; P = .01). They more frequently received open peripheral vascular interventions (40% vs 10%; P = .002) and developed compartment syndrome (13% vs 2%; P = .04) during hospitalization. There were 110 deaths (35%). On multivariable analysis, prehospital cardiac arrest (odds ratio [OR], 8.47; 95% confidence interval [CI], 1.47-48.66; P = .02), penetrating vs blunt trauma (OR, 5.5; 95% CI, 1.05-28.82; P = .04), increased age (OR, 1.06; 95% CI, 1.03-1.1; P < .001), increased Injury Severity Score (OR, 1.05; 95% CI, 1-1.1; P = .03), and decreased total Glasgow Coma Scale score (OR, 0.85; 95% CI, 0.76-0.95; P = .005) were associated with increased mortality. The majority of major amputations in patients undergoing REBOA are trauma related from injuries sustained before admission. Injury type and severity as well as initial hemodynamic derangements are associated with mortality after REBOA. Despite concerns about limb complications of REBOAs, baseline injuries appear to be the primary cause of limb loss, but further prospective analysis is needed.

Impact of the Pediatric Emergency Care Applied Research Network (PECARN) guidelines on emergency department use of head computed tomography at a level I safety-net trauma center.

To evaluate whether the emergency department usage of head computed tomography (CT) on pediatric patients with minor head trauma changed after publication of the Pediatric Emergency Care Applied Research Network (PECARN) head CT guidelines and to identify risk factors associated with performing head CT on patients without a PECARN guideline indication. This retrospective study included 484 patients 18years of age or younger who presented to the emergency department with head injury and a total Glasgow Coma Scale score ≥ 14 between September 2005 and July 2014. Based on the guideline publication date of September 2009, the study cohort was stratified into pre-guideline and post-guideline groups. Head CT performance, indications, and findings were compared between study periods. Logistic regression was used to identify risk factors associated with performing a non-indicated head CT. The rate of head CTs performed did not significantly change in the post-guideline period (96.6% vs. 95.7%, p = 0.63). There was no significant difference in the proportion of head CTs performed in patients with indications for head CT (100.0% vs. 100.0%) nor in patients without an indication for head CT (85.7% vs. 82.6%, p = 0.65) between the study periods. Females were significantly more likely to have a non-indicated head CT (OR: 2.73, 95% CI: 1.67-4.45) performed. Head CT ordering practices for pediatric patients with head injury did not change at a level I trauma center after publication of the PECARN head CT guidelines.

Timing of Pharmacologic Venous Thromboembolism Prophylaxis in Severe Traumatic Brain Injury: A Propensity-Matched Cohort Study

Patients with severe traumatic brain injury (sTBI) are at high risk for developing venous thromboembolism (VTE). Nonetheless, pharmacologic VTE prophylaxis is often delayed out of concern for precipitating extension of intracranial hemorrhage (ICH). The purpose of this study was to compare the effectiveness of early vs late VTE prophylaxis in patients with sTBI, and to characterize the risk of subsequent ICH-related complication. Adults with isolated sTBI (head Abbreviated Injury Scale score ≥3 and total Glasgow Coma Scale score ≤8) who received VTE prophylaxis with low-molecular-weight or unfractionated heparin were derived from the American College of Surgeons Trauma Quality Improvement Program (2012 to 2014). Patients were divided into EP (<72 hours) or LP (≥72 hours) groups. Propensity score matching was used to minimize selection bias. The primary end point was VTE (pulmonary embolism or deep vein thrombosis). Secondary outcomes were defined as late neurosurgical intervention (≥72 hours) or death. We identified 3,634 patients with sTBI. Early prophylaxis was given in 43% of patients. Higher head injury severity, presence of ICH, and early neurosurgery were associated with late prophylaxis. Propensity score matching yielded a well-balanced cohort of 2,468 patients. Early prophylaxis was associated with lower rates of both pulmonary embolism (odds ratio= 0.48; 95% CI, 0.25-0.91) and deep vein thrombosis (oddsratio= 0.51; 95% CI, 0.36-0.72), but no increase in risk of late neurosurgical intervention or death. In this observational study of patients with sTBI, early initiation of VTE prophylaxis was associated with decreased risk of pulmonary embolism and deep vein thrombosis, but no increase in risk of late neurosurgical intervention or death. Early prophylaxis may be safe and should be the goal for each patient in the context of appropriate risk stratification.

Data quality of a wearable vital signs monitor in the pre-hospital and emergency departments for enhancing prediction of needs for life-saving interventions in trauma patients

This study was designed to investigate the quality of data in the pre-hospital and emergency departments when using a wearable vital signs monitor and examine the efficacy of a combined model of standard vital signs and respective data quality indices (DQIs) for predicting the need for life-saving interventions (LSIs) in trauma patients. It was hypothesised that prediction of needs for LSIs in trauma patients is associated with data quality. Also, a model utilizing vital signs and DQIs to predict the needs for LSIs would be able to outperform models using vital signs alone. Data from 104 pre-hospital trauma patients transported by helicopter were analysed, including means and standard deviations of continuous vital signs, related DQIs and Glasgow coma scale (GCS) scores for LSI and non-LSI patient groups. DQIs involved percentages of valid measurements and mean deviation ratios. Various multivariate logistic regression models for predicting LSI needs were also obtained and compared through receiver-operating characteristic (ROC) curves. Demographics of patients were not statistically different between LSI and non-LSI patient groups. In addition, ROC curves demonstrated better prediction of LSI needs in patients using heart rate and DQIs (area under the curve [AUC] of 0.86) than using heart rate alone (AUC of 0.73). Likewise, ROC curves demonstrated better prediction using heart rate, total GCS score and DQIs (AUC of 0.99) than using heart rate and total GCS score (AUC of 0.92). AUCs were statistically different (p < 0.05). This study showed that data quality could be used in addition to continuous vital signs for predicting the need for LSIs in trauma patients. Importantly, trauma systems should incorporate processes to regulate data quality of physiologic data in the pre-hospital and emergency departments. By doing so, data quality could be improved and lead to better prediction of needs for LSIs in trauma patients.

Improving the prediction of mortality and the need for life-saving interventions in trauma patients using standard vital signs with heart-rate variability and complexity.

The goal of this study was to determine the effectiveness of using traditional and new vital signs (heart rate variability and complexity [HRV, HRC]) for predicting mortality and the need for life-saving interventions (LSIs) in prehospital trauma patients. Our hypothesis was that statistical regression models using traditional and new vital signs would be superior in predictive performance over models using standard vital signs alone. This study involved 108 prehospital trauma patients transported from the point of injury via helicopter. Heart rate variability and HRC were calculated using criterion standard R-R interval sequences manually verified from the patients' electrocardiograms. Means and standard deviations for vital signs, HRV, HRC, and Glasgow coma scale (GCS) scores were obtained for nonsurvivors versus survivors and LSI versus non-LSI patient groups and then compared using Wilcoxon statistical tests. Receiver-operating characteristic curves were also obtained to compare different regression models for predicting mortality and the need for LSIs. Seventeen patients (16%) died. Eighty-two patients (76%) received a total of 142 LSIs. Receiver-operating characteristic curves demonstrated better prediction of mortality and LSI needs using heart rate and HRC (area under the curve [AUC]; AUCs, 0.86 and 0.86) than using heart rate alone (AUCs, 0.79 and 0.57). Likewise, receiver-operating characteristic curves demonstrated better prediction using total GCS score and HRC (AUCs, 0.82 and 0.97) than using total GCS score (AUCs, 0.81 and 0.91). Similar results were obtained for heart rate and HRV (AUCs, 0.86 and 0.73). The major implication of this study was that traditional and new vital signs (HRV and HRC) should be used simultaneously to improve prediction of mortality and the need for LSIs in prehospital trauma patients during all echelons of trauma care. Improvements in the timely use and diagnostic accuracy of transportable vital signs monitors will require use of traditional and new vital signs from the trauma patient cohort.

Comparing Model Performance for Survival Prediction Using Total Glasgow Coma Scale and Its Components in Traumatic Brain Injury

The Glasgow Coma Scale (GCS) score is used in clinical practice for patient assessment and communication among clinicians and also in outcome prediction models such as the Trauma and Injury Severity Score (TRIS). The objective of this study is to determine which GCS subscore is best associated with outcome, taking time of assessment into account. Records of patients with brain injury who presented after 1989 were extracted from the Trauma Audit and Research Network (TARN) database. Using logistic regression, a baseline model was derived with age, Injury Severity Score (ISS), and year of injury as covariates and survival at discharge as the dependent variable. Total GCS, its subscores, and their combinations at various time points were separately added to the baseline model to compare their effect on model performance. The dataset contained 21,657 cases. The total GCS score at scene and its subscores had significantly lower predictive power compared with those recorded on arrival at the Emergency Department (ED) (scene total GCS: Area Under the Curve-AUC: 0.89; 95% confidence interval [CI]: 0.89-0.90) and Nagelkerke R(2) of 0.55, admission total GCS: AUC of 0.91; 95% CI: 0.91-0.91, and Nagelkerke R(2) of 0.59). Eye and verbal subscores had significantly lower performances compared with total GCS, motor subscore, and various combinations of subscores. Motor subscore and total GCS appeared to have similar predictive performance (admission total and motor GCS both had AUC of 0.91 (95% CI: 0.91-0.92) and Nagelkerke R(2) of 0.59 and 0.58, respectively). Motor subscore contains most of the predictive power of the total score. GCS on arrival is a significantly better predictor of outcome than that recorded at scene.

Clinical Significance of Plasma Ammonia in Patients with Generalized Convulsion

Plasma ammonia has been used in emergency departments to assess whether or not generalized convulsion attacks exist in patients who are suspected of having convulsions. However, there are few reports that have assessed the relationship between generalized convulsions and hyperammonemia. The clinical significance of plasma ammonia measurements in the diagnosis of generalized convulsions is investigated in this study. A total of 293 patients who were transported by ambulance to the emergency department of St. Luke's International Hospital, Tokyo, Japan under suspicion of convulsive seizure or disturbance of consciousness were studied. The objectives were divided into two groups--"Convulsion" and "Non-convulsion"--according to the information provided by witnesses. Bivariate and multivariate analyses were carried out for patient background, clinical course, past medical history and blood test results. All 11 items showing significant differences on the bivariate analysis were included in the multivariate analysis. Of these, age, total Glasgow Coma Scale score, plasma ammonia level and arterial lactate level showed a significant difference and are recognized as independent findings for the diagnosis of generalized convulsion. The plasma ammonia level had an odds ratio of 14.8 (95% CI, 3.2 to 111.5; p<0.01), 53% sensitivity and 90% specificity when 65 µg/dL was used as the cut-off value. Plasma ammonia values rise during generalized convulsion. Measurement of plasma ammonia is clinically highly significant as an independent finding during the diagnosis of generalized convulsion.

Prediction of Mortality and of the Need for Massive Transfusion in Casualties Arriving at Combat Support Hospitals in Iraq

Our purpose was to compare the Revised Trauma Score (RTS) with the new Field Triage Score (FTS) for prediction of mortality (MORT) and of need for massive transfusion (MASS, >or=10 units of packed cells or whole blood) in casualties arriving at combat support hospitals in Iraq. Six hundred ninety-two cases were reviewed; 536 had complete data and were included. Total Glasgow Coma Scale score (GCS total) not GCS motor was used. Thus, a modification (FTS 07) of the FTS was calculated, using GCS <8 and systolic arterial pressure (SAP) <100 as cut-points, with range 0 to 2. Variables different by univariate analysis underwent logistic regression analysis (LRA) and areas under the curve for receiver operating characteristic curves (AUC) were calculated. By LRA, probability of an outcome is given by p = e(k)/(1 + e(k)). By LRA for MORT, k = 0.616 - 0.438 x RTS; AUC = 0.708. When used instead of RTS, FTS 07 provided k = -0.716 - 1.009 x FTS 07; AUC = 0.687 (NS). For MASS, k = 0.638 - 0.115 x RTS - 0.011 x DAP + 0.358 x SI, where DAP is diastolic arterial pressure and SI is shock index, i.e., heart rate or SAP; AUC = 0.638. When used instead of RTS, FTS 07 provided k = -0.740 - 0.376 x FTS 07- 0.011 x DAP; AUC = 0.618 (NS). RTS emerged as the best predictor of MORT, with FTS 07 a close surrogate. This indicates the effect of impaired mentation on MORT in these data. For prediction of MASS, RTS as well as the heart rate and blood pressure predominated. The advantage of FTS 07 (or original FTS) over RTS is the former's ease of computation.