Comparison of Systemic Inflammatory Response Syndrome Score, Triage Score, and Triage-Revised Trauma Score as Triage Tools for Trauma Patients in the Emergency Department

Lee, Jun Ho; Hwang, Seong Youn; Cho, Kwang Won; Choi, Young Cheol

Abstract

PURPOSE
Since the definition of the systemic inflammatory response syndrome (SIRS) was introduced in 1992, it has been a useful indicator in predicting the extent of severity in and the prognosis for medical, surgical, and trauma patients. Indicators such as the Triage Score (TS) and the Triage-Revised Trauma Score (t-RTS) have been used as triage tools for emergency trauma patients in Korea. This study was performed to evaluate the ability of these three indicators as triage tools for trauma patients admitted into an emergency center.
METHODS
The medical records of five hundred seven consecutive trauma patients admitted to the Emergency Center of Masan Samsung Hospital from October 2004 to December 2004 were carefully examined prospectively and retrospectively, and three hundred ninety-one patients were selected as subjects for this research. The SIRS score, the TS, and the t-RTS were calculated based on the records from the Emergency Department, and the injury severity score was calculated based on all the data obtained during hospitalization. The efficiency of the three indicators as triage tools was evaluated by using cross tabulations in two by two matrices and by using a receiver operating characteristic (ROC) curve analysis. RESULT: When mortality was used as the outcome parameter, the sensitivity of the SIRS score was lower than that of the TS (p<0.05), and the specificity and the accuracy of the SIRS score were lower than those of the t-RTS (p<0.01). The areas under the ROC curves of the SIRS score, the TS, and the t-RTS were 0.759+/-0.095, 0.949+/-0.033, and 0.900+/-0.085, respectively (95% confidence interval, p<0.002, vs. TS). When an injury severity score of 15 was used as the outcome parameter, the comparisons of the sensitivities, the specificities and the accuracies of the SIRS score and the other two indicators showed the same pattern as mentioned above, and the areas under the ROC curves of the SIRS score, the TS, and the t-RTS were 0.688+/-0.058, 0.762+/-0.059, and 0.686+/-0.067, respectively (95% confidence interval).
CONCLUSION
The ability of SIRS score was the same as, or lower than, that of the TS and the t-RTS. Therefore, the SIRS score cannot be recommended over the other two indicators as triage tools for emergency trauma patients.