Prognostic models for the early care of trauma patients: a systematic review

We systematically reviewed models for the early care of trauma patients that included 2 or more predictors obtained from the evaluation of an adult trauma victim, investigated their quality and described their characteristics.We screened 4 939 records for eligibility and included 5 studies that derivate 5 prognostic models and 9 studies that validate one or more of these models in external populations. All prognostic models intended to change clinical practice, but none were tested in a randomised clinical trial. The variables and outcomes were valid, but only one model was derived in a low-income population. Systolic blood pressure and level of consciousness were applied as predictors in all models.The general impression is that the models perform well in predicting survival. However, there are many areas for improvement, including model development, handling of missing data, analysis of continuous measures, impact and practicality analysis.Trauma is a major global contributor to premature death and disability. The burden of injuries is especially notable in low and middle-income countries and is expected to rise during the coming decades [1,2]. Harm from major trauma may be minimized through early access to pre-hospital [2] and in-hospital trauma care [3]. A majority of trauma related deaths occur during the pre-hospital period or in the initial hours after injury. Emergency medical service (EMS) providers must therefore rapidly assess trauma severity in order to identify patients that require prompt referral to an appropriate hospital [2,3] and to ensure that necessary diagnostic and therapeutic interventions are initiated upon admission. However, early recognition of major trauma remains a challenge due to occult injuries, unpredictable evolution of symptoms, and the complexities of evaluating patients in the early hours after injury.If patients only suffering minor injuries bypass the local clinic (overtriage; false-positives), the regional hospital will be ove