Kuza, Catherine M; Matsushima, Kazuhide; Mack, Wendy J; Pham, Christopher; Hourany, Talia; Lee, Jessica; Tran, Thang D; Dudaryk, Roman; Mulder, Michelle B; Escanelle, Miguel A; Ogunnaike, Babatunde; Ahmed, M Iqbal; Luo, Xi; Eastman, Alexander; Imran, Jonathan B; Melikman, Emily; Minhajuddin, Abu; Feeler, Anne; Urman, Richard D; Salim, Ali; Spencer, Dean; Gabriel, Viktor; Ramakrishnan, Divya; Nahmias, Jeffry T

doi:10.1016/j.amjsurg.2019.09.019

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The role of the American Society of anesthesiologists physical status classification in predicting trauma mortality and outcomes

Published Web Location

https://doi.org/10.1016/j.amjsurg.2019.09.019

Abstract

Background

Trauma prediction scores such as Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS)) are used to predict mortality, but do not include comorbidities. We analyzed the American Society of Anesthesiologists physical status (ASA PS) for predicting mortality in trauma patients undergoing surgery.

Methods

This multicenter, retrospective study compared the mortality predictive ability of ASA PS, RTS, Injury Severity Score (ISS), and TRISS using a complete case analysis with mixed effects logistic regression. Associations with mortality and AROC were calculated for each measure alone and tested for differences using chi-square.

Results

Of 3,042 patients, 230 (8%) died. The AROC for mortality for TRISS was 0.938 (95%CI 0.921, 0.954), RTS 0.845 (95%CI 0.815, 0.875), and ASA PS 0.886 (95%CI 0.864, 0.908). ASA PS + TRISS did not improve mortality predictive ability (p = 0.18).

Conclusions

ASA PS was a good predictor of mortality in trauma patients, although combined with TRISS it did not improve predictive ability.

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