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Scala_2025_SpringerBMC_s13049-025-01511-2
Journal article

Effect of different factors on predicting patient mortality beyond the NACA classification : a multivariate analysis of more than 2,000 polytrauma patients

  • Scala, Isabel Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Riegger, Martin ORCID Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  • Bensa, Alessandro ORCID Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  • Monteleone, Andrea Stefano ORCID Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland - Sonnenhof Orthopaedic Clinic, Swiss Leading Hospitals, Bern, Switzerland
  • Fiore, Paolo Ivan ORCID Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  • Candrian, Christian ORCID Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
  • Filardo, Giuseppe ORCID Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
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  • 2025
Published in:
  • Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - 2025, vol. 33, no. 1, p. 202
Polytrauma
Registry
NACA score
Emergency medicine
GCS
ISS
English Background: The National Advisory Committee for Aeronautics (NACA) score is widely used to assess polytrauma patients. NACA scores of 4 and 5 indicate severe and potentially life-threatening injuries. However, these two categories are rather broad, with a large variety of conditions within each level. Aim of this study was to investigate a large cohort of NACA 4 and NACA 5 trauma patients and quantify the impact of individual factors on the mortality risk. Methods: The polytrauma registry of the Lugano Regional Hospital affiliated to the National Swiss Trauma Registry (STR) was retrospectively analysed to investigate all patients admitted between 2015 and 2023 with a NACA score of 4 or 5. Out of 2,152 patients, 1,684 were NACA 4 and 468 were classified as NACA 5. Extracted parameters included age, mechanism of injury, NACA score, prehospital variables and hospital variables, and patient diagnoses. Univariate and multivariate analyses were performed for all patients combined and separately for NACA 4 and NACA 5 subgroups. Results: A total of 121 patients died during hospitalization. The multivariate analysis of the prehospital variables showed that NACA score (OR 2.96), age (OR 1.11), Glasgow Coma Scale (GCS) (OR 0.78), cardiopulmonary resuscitation (CPR) (OR 7.22), and administration of vasoactive drugs (OR 2.38) were statistically significant independent risk factors for all included patients (p < 0.05). In the NACA 4 subgroup analysis only age (OR 1.13) and GCS (OR 0.69) emerged as statistically significant predictors of mortality (p < 0.05). In the NACA 5 subgroup, age (OR 1.09), GCS (OR 0.28), and administration of vasoactive drugs (OR 2.40) emerged as statistically significant predictors of mortality (p < 0.05). Conclusion: This study demonstrated that different factors can influence the mortality risk of polytrauma patients beyond the mere NACA 4 and 5 classification, including CPR, administration of vasoactive drugs, GCS, and age. These findings highlight the association between specific clinical parameters and the mortality risk, whose early identification is paramount for a more targeted management of polytrauma patients. Level of Evidence (LoE): III
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Language
  • English
Classification
Medicine
License
CC BY-NC-ND
Open access status
gold
Identifiers
Persistent URL
https://n2t.net/ark:/12658/srd1335505
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