A novel scoring system to predict the requirement for surgical intervention in victims of motor vehicle crashes: Development and validation using independent cohorts

Ryo Yamamoto, Tomohiro Kurihara, Junichi Sasaki

Research output: Contribution to journalArticle

Abstract

Background Given that there are still considerable number of facilities which lack surgical specialists round the clock across the world, the ability to estimate the requirement for emergency surgery in victims of motor vehicle crashes (MVCs) can ensure appropriate resource allocation. In this study, a surgical intervention in victims of MVC (SIM) score was developed and validated, using independent patient cohorts. Methods We retrospectively identified MVC victims in a nationwide trauma registry (2004–2016). Adults ≥ 15 years who presented with palpable pulse were included. Patients with missing data on the type/date of surgery were excluded. Patient were allocated to development or validation cohorts based on the date of injury. After missing values were imputed, predictors of the need for emergency thoracotomy and/or laparotomy were identified with multivariate logistic regression, and scores were then assigned using odds ratios. The SIM score was validated with area under the receiver operating characteristic curve (AUROC) and calibration plots of SIM score-derived probability and observed rates of emergency surgery. Results We assigned 13,328 and 12,348 patients to the development and validation cohorts, respectively. Age, motor vehicle collision and vital signs on hospital arrival were identified as independent predictors for emergency thoracotomy and/or laparotomy, and SIM score was developed as 0–9 scales. The score has a good discriminatory power (AUROC = 0.79; 95% confidence interval = 0.77–0.81), and both estimated and observed rates of emergency surgery increased stepwise from 1% at a score ≤ 1 to almost 40% at a score ≥ 8 with linear calibration plots. Conclusions The SIM score was developed and validated to accurately estimate the need for emergent thoracotomy and/or laparotomy in MVC victims.

Original languageEnglish
Article numbere0226282
JournalPloS one
Volume14
Issue number12
DOIs
Publication statusPublished - 2019 Jan 1

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Motor Vehicles
Emergencies
Surgery
laparotomy
Thoracotomy
surgery
Laparotomy
ROC Curve
Calibration
calibration
Resource Allocation
Vital Signs
Wounds and Injuries
resource allocation
odds ratio
Resource allocation
Registries
Logistics
Clocks
confidence interval

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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A novel scoring system to predict the requirement for surgical intervention in victims of motor vehicle crashes : Development and validation using independent cohorts. / Yamamoto, Ryo; Kurihara, Tomohiro; Sasaki, Junichi.

In: PloS one, Vol. 14, No. 12, e0226282, 01.01.2019.

Research output: Contribution to journalArticle

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