The AdHOC (age, head injury, oxygenation, circulation) score: a simple assessment tool for early assessment of severely injured patients with major fractures

Abstract

Purpose: We sought to develop a simple, effective and accurate assessment tool using well-known prognostic parameters to predict mortality and morbidity in severely injured patients with major fractures at the stage of the trauma bay. Methods: European Data from the TraumaRegister DGU® were queried for patients aged 16 or older and with an ISS of 9 and higher with major fractures. The development (2012–2015) and validation (2016) groups were separated. The four prognostic aspects Age, Head injury, Oxygenation and Circulation along with parameters were identified as having a relevant impact on the outcome of severely injured patients with major fractures. The performance of the score was analyzed with the area under the receiver operating characteristics curve and compared to other trauma scores. Results: An increasing AdHOC (Age, Head injury, Oxygenation, Circulation) score value in the 17,827 included patients correlated with increasing mortality (0 points = 0.3%, 1 point = 5.3%, 2 points = 15.6%, 3 points = 42.5% and 4 points = 62.6%). With an AUROC of 0.858 for the development (n = 14,047) and 0.877 for the validation (n = 3780) group dataset, the score is superior in performance compared to the Injury Severity Score (0.806/0.815). Conclusion: The AdHOC score appears to be easy and accessible in every emergency room without the requirement of special diagnostic tools or knowledge of the exact injury pattern and can be useful for the planning of further surgical treatment.