Development of new scoring system predicting angiographic embolization and surgical bleeding control in EMS assessed trauma: Haemostasis Intervention for Trauma, Scoring system “HITS”

Introduction Trauma is an important public health issue and one of leading causes of mortality worldwide. We developed concise new scoring system which predict possibility of haemostasis intervention in EMS-assessed trauma patients. Material & Method Two Asian-Pacific countries have been involved in this study: 13 emergency departments in South Korea and 15 emergency departments in Malaysia. Trauma patients from January 2015 to December 2018 were enrolled. Paediatric, non-traumatic injured, inter-hospital transport case, non-EMS user, cardiac arrest, patient with missing information were excluded. Haemostasis intervention was defined as the presence of at least one of surgical bleeding control and angiographic embolization. Simple scoring equation was developed after principal component analysis with key components. Prediction performance was compared to single indicators and revised trauma score (RTS), primarily by plotting specific receiver operating characteristic (ROC) curves. Test characteristics including the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) with 95% CIs, were reported. Since prediction performance would be differ by gender, additional sensitivity analysis was conducted. Result Total 28,695 cases were selected for final analysis. Overall, 8,128 (28.3%) of patients received surgical bleeding control and 5,385 (18.8%) received angiographic embolization. After principal component analysis, new scoring system, HITS - haemostasis intervention for trauma, scoring system was developed as below. HITS: Scene Shock Index (SI) + 1.53 x Emergency Department (ED) SI + 0.73 x Delta SI 0.62 x prehospital alertness HITS showed greater predictive performance for haemostasis intervention (AUC: 0.742 for HITS, 0.574 for Scene SI, 0.582 for ED SI and 0.524 for RTS) and especially for angiographic embolization (AUC: 0.817 for HITS, 0.580 for Scene SI, 0.587 for ED SI and 0.505 for RTS). HITS achieved highest PPV and NPV compared to other models also. Sensitivity analysis showed greater predictive value for angiographic embolization in female cohort. Conclusion New scoring system can predict needs for hameostasis intervention well compared to single predictors or RTS. It can be used as decision supporting tool for determine receiving hospital or ED bypass.