Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prediction of outcome in major trauma

Introduction

This prospective study examines the efficacy of the predicting power for mortality of two different prehospital scoring systems in major trauma. We present an improved MEES in combination with capnometry. MEES combined with capnometry (MEESc) is a new scoring system.

Patients and methods

In a prehospital setting, values of the MEES and capnometry (initial and final) were collected from each patient. We added the final values of partial pressure of end-tidal CO₂ (petCO₂) to the MEES scoring system and ranked them from 0 to 2 so that the final maximum sum of this scoring system would be 30 without any change in the minimum score being 10. This study was undertaken over 3 years (January 2000–March 2003) and included 58 consecutive patients hospitalized for major trauma (defined as Injury Severity Score > 15) requiring intubation at the roadside and in whom the prehospital petCO₂ had been recorded. Patients younger than 16 years old were excluded from the study. There were 48 males and 10 females. Their ages varied from 16 to 82 years with a mean of 43.5 ± 15.7 years. For every scoring system the sensitivity, specificity, correct prediction outcome and area under the ROC curve was determined. The results was compred with McNemar's test in Z score. The significant difference is P < 0.05.

Results

For prediction of mortality, the best cutoff points were 19 for MEES and 22 for MEESc. The Youden index has the best cutoff points at 0.51 for MEES and 0.67 for MEESc (P < 0.05). The correct predicting outcome in percent was 71.3 for MEES and 83.5 for MEESc (P < 0.05). The area under the ROC curve was 0.72 in the MEES and 0.85 for MEESc (P < 0.05).

Conclusion

There were significant differences among MEES and MEESc. The MEESc improve the results of MEES. The prehospital use of the improved MEESc system could be an efficient communication protocol between the prehospital and hospital settings.