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Model Assessment
Published in Gary L. Rosner, Purushottam W. Laud, Wesley O. Johnson, Bayesian Thinking in Biostatistics, 2021
Gary L. Rosner, Purushottam W. Laud, Wesley O. Johnson
We have discussed situations where posterior probabilities that regression coefficients were positive (or negative) are quite large, say greater than 0.95. We have asserted that the corresponding regression effect was statistically important in this instance. Statistical importance is to be contrasted with practical importance. For example, the analysis of the trauma data with a diffuse prior was reported in Table 8.4. The posterior median and 95% probability interval for the regression coefficient that corresponds to the revised trauma score (RTS) was . The posterior probability that this coefficient is negative is virtually 1, so there is clear statistical importance of this variable. One would not think of removing this variable from the model. Furthermore, looking at Figure 8.1, we can clearly see the practical importance of this variable. For example, the estimated probability of death for 60-year-olds with injury severity of 40 is about 0.6 with the larger RTS and about 0.8 with the smaller RTS. This is quite a noticeable difference and much more relevant to judging practical importance than the actual estimate of the regression coefficient and its uncertainty interval.
Organizing the community for pediatric trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Eric H. Rosenfeld, Arthur Cooper
Most regional pediatric prehospital trauma triage criteria are based upon the original American College of Surgeons Field Trauma Triage Decision Scheme, which includes anatomic, physiologic, mechanistic, and comorbid criteria including age less than 5, and which have been twice revised since this monograph was first published [101, 102]. The PTS was also developed as a field triage tool that correlates closely with ISS as a predictor of mortality [103]. However, the Revised Trauma Score performs nearly as well as the PTS—despite the fact that it is based upon adult vital signs—presumably because abnormalities in respiratory rate (RR) and GCS score tend to correlate in seriously injured pediatric patients, most of whom have serious traumatic brain injury, thereby giving “double weight” to those components of the score most likely to be abnormal following head injury [104]. Yet, both scores require calculation in the busy prehospital setting, calling for simpler tools requiring no added calculations that would minimize both undesirable overtriage and unacceptable undertriage.
Principles of resuscitation and polytrauma management
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Daud Chou, Matthew Barry, Karim Brohi
The Revised Trauma Score (RTS) is a physiologically based scoring system calculated by incorporating the respiratory rate, systolic blood pressure and Glasgow Coma Scale (GCS) score. Each parameter is assigned a score between 0 and 4, with 0 as the worst score and 4 representing normal physiology. A score of less than 11 has been suggested as the threshold for transfer to a trauma centre.
Correlation Between the Revised Trauma Score and Injury Severity Score: Implications for Prehospital Trauma Triage
Published in Prehospital Emergency Care, 2019
Samuel M. Galvagno, Michael Massey, Pierre Bouzat, Roumen Vesselinov, Matthew J. Levy, Michael G. Millin, Deborah M. Stein, Thomas M. Scalea, Jon Mark Hirshon
While field trauma triage protocols continue to be revised and updated, the ability of these schemes to predict outcomes remains imprecise. More than 50 scoring systems have been published for the prediction of outcomes in trauma patients (11–16) (Table 1). The most frequently used trauma scores are the Abbreviated Injury Score (AIS), Injury Severity Score (ISS) (17), Revised Trauma Score (RTS), New Injury Severity Score (NISS) (18,19), GAP score (Glasgow Coma Scale, age, blood pressure), and MGAP score (mechanism of injury, Glasgow Coma Scale, age, blood pressure) (11). These scoring systems are categorized as anatomical or physiological; the Trauma Related Injury Severity Score (TRISS) combines the ISS, RTS, and age to estimate predicted probability of survival (20–22).
Association of Interfacility Helicopter versus Ground Ambulance Transport and in-Hospital Mortality among Trauma Patients
Published in Prehospital Emergency Care, 2021
Kenneth Stewart, Tabitha Garwe, Babawale Oluborode, Zoona Sarwar, Roxie M. Albrecht
Additional clinical factors collected at the TTC included initial vital signs (systolic blood pressure (SBP), heart rate (HR), respiratory rate (RR)), Glasgow Coma Score (GCS), weighted revised trauma score, severe head injury (AIS> =3), and final ISS. Emergency department (ED) disposition, minutes spent in the ED (EDMins), hospital length of stay in hours (LOS), hospital discharge disposition, and mortality were also collected. The primary outcome of interest, mortality, was considered at two different time points: within the first 72 hrs and within the first 2 weeks. The 2 week time point was chosen because it seemed unlikely mortality beyond that point could be related to inter-facility mode of transport.
Dutch Prospective Observational Study on Prehospital Treatment of Severe Traumatic Brain Injury: The BRAIN-PROTECT Study Protocol
Published in Prehospital Emergency Care, 2019
Sebastiaan M. Bossers, Christa Boer, Sjoerd Greuters, Frank W. Bloemers, Dennis Den Hartog, Esther M. M. Van Lieshout, Nico Hoogerwerf, Gerard Innemee, Joukje van der Naalt, Anthony R. Absalom, Saskia M. Peerdeman, Matthijs de Visser, Stephan Loer, Patrick Schober
The data-manager identifies the included patients in participating trauma centers, based on matches between prehospital information (e.g., date and time of arrival at hospital, gender, trauma mechanism and other characteristic information) and queries performed in the trauma centers. Subsequently, the data manager collects follow-up data as well as previous medical history data. These data include the following: Medical history, including preinjury medication.First vital parameters in the emergency department.First in-hospital laboratory values.First key interventions.Cerebral CT imaging results [observed injuries, Marshall score (26), Rotterdam score (27)].Other detected injuries.Operations in the first 48 hours.Revised Trauma Score (RTS) (28).Abbreviated Injury Scale (AIS) scores (until 2014, the 1995 version, update 1998 was used; as of 2015, the 2005 version, update 2008 was used across all trauma centers) (29).Injury Severity Score (30).