Research On The Application Of Chinese Version Of The Denver Emergency Department Trauma Organ Failure Score In Trauma Patients

Objectives1.To translate English version of the Denver Emergency Department Trauma Organ Failure(Denver ED TOF)Score into Chinese and test the reliability and validity of Chinese version of the Denver ED TOF Score in trauma patients.2.To analyze optimal cut-off points of Chinese Denver ED TOF Score for predicting post-traumatic MOF and death risk in trauma patients.3.To compare diagnostic value and predictive performance of Chinese Denver ED TOF Score,MEWS and RTS for predicting death risk in trauma patients.Methods1.The original Denver ED TOF Score was translated into Chinese and back translated and modified for cultural adaptation according to guidelines.From May2016 to March 2017,a survey using Chinese Denver ED TOF Score was conducted on 313 trauma patients recruited using convenience sampling method from emergency department to verify its reliability and validity.Trauma patients were investigated using the general socio-demographic questionnaire,Chinese Denver ED TOF Score and Sepsis-related Organ Failure Assessment.Took MOF occurred on trauma patients in hospital within 7 days as outcome index to analyze the optimal cut-off point of Chinese Denver ED TOF Score by using ROC curve.2.From January 2015 to August 2017,clinical history of all trauma patients were collected retrospectively.These patients were recruited from emergency department of a first-class comprehensive hospital in Tianjin.A total of 718 trauma patients were selected after screening cases according to the inclusion and exclusion criteria strictly.Data were collected using the general socio-demographic questionnaire,MEWS,RTS,Chinese Denver ED TOF Score and GCS.Took death occurred on trauma patients during the hospitalization period as outcome index to analyze the optimal cut-off point of Chinese Denver ED TOF Score by using the ROC curve.The difference on diagnostic value and predictive efficiency of three scores were analyzed by comparing the area under the ROC curve.Results1.Psychometric characteristics of Chinese Denver ED TOF Score: Chinese Denver ED TOF Score included 6 items.The Cronbach's ? coefficient of the total scale was 0.738,and the Cronbach's ? coefficient of 3 dimensions were 0.729,0.715 and 0.715 respectively.The ICC of inter-observer was 0.994.The item-level CVI valued 0.80 to 1.00,and the scale-level CVI valued 0.93.Three common factors were extracted,which explained 63.327% of variance of the total scale.The optimal cut-off point of Chinese Denver ED TOF Score was two.Its sensitivity,specificity,PPV and NPV are 84.0%,81.6%,28.38% and 98.33% respectively.The AUC of Chinese Denver ED TOF Score was 0.878(95%CI: 0.812~0.944,P<0.01).2.Prediction efficiency of Chinese Denver ED TOF Score for evaluating on death risk in trauma patients: The optimal cut-off point of Chinese Denver ED TOF Score was four,and its sensitivity,specificity,PPV and NPV were 90.3%,76.6%,14.81% and 99.43% respectively.Its AUC was 0.920(95%CI: 0.872~0.974,P<0.01).The AUCs of Chinese Denver ED TOF Score,MEWS and RTS were above 0.90(MEWS>Chinese Denver ED TOF Score>RTS),were of approximate diagnostic value.There was no statistical difference on the AUCs of three scores(P>0.05).Conclusions1.In this study,Chinese version of Denver ED TOF Score showed good reliability and validity.Its diagnostic value is the medium level for predicting of post-traumatic MOF,and the optimal cut-off point was two.Chinese Denver ED TOF Score is recommended as an assessment tool to early recognize and predict of post-traumatic MOF in trauma patients.2.The optimal cut-off point of Chinese Denver ED TOF Score was four.Chinese Denver ED TOF Score belongs to high diagnostic value assessment tool.The items of Chinese Denver ED TOF Score are all objective indicators,and high sensitivity and NPV,so its prediction performance is good.Medical personnel can early identify trauma patients with high risk of death,implement the goal-directed recovery and intervention treatment actively,do early warning and grading nursing care in order to improve outcome of trauma patients.