MURRAY — Accidents happen, but researchers in Utah have found that a simple blood test often performed upon admission to a hospital can predict the likelihood of trauma leading to death.
"It could possibly help families make decisions if they have a better idea of how the patient is going to do down the road," said Dr. Sarah Majercik, a trauma surgeon at Intermountain Medical Center. She is part of a team of researchers who discovered how a tool already in use can be used to improve patient care at critical times.
"Families and patients often want to know how they're going to do," she said.
Researchers studied data from more than 9,500 patients admitted to the hospital with trauma during a six-year period. They discovered that some patients are up to 58 times more likely to die than others, regardless of the severity of their original injury.
The probability of death, researchers found, can be determined by applying the Intermountain Risk Score, a computerized algorithm that measures various components of a complete blood count, a metabolic panel and other factors, such as gender and age, which are generally known for every patient admitted at the hospital.
Benjamin Horne, director of cardiovascular and genetic epidemiology at the Intermountain Medical Center Heart Institute, has been using the approach for several years to evaluate individuals with medical problems like heart failure or chronic pulmonary disease.
He said doctors typically have to observe patients for several hours to see how they respond to various treatment before a determination on outcomes can be made, whereas the risk score can let them know in as long as it takes for blood tests to be evaluated, which is about an hour.
The score, Horne said, provides information that doctors eventually learn, but earlier in the care process and in a format they're used to.
"Our primary hope is that it will improve care for patients and that trauma patients will have better outcomes and be able to leave the hospital earlier but in a healthier state," he said.
In addition to giving doctors important information to consider when talking about a patient's prognosis to families, having a better assessment will allow them to better prioritize care and take additional precautions with patients who are at greatest risk.
"We are at a disadvantage as trauma surgeons," Majercik said. "Patients come to us and we don't know anything about them, just what the family tells us. This gives us a clue into their pre-existing physiology."
Other available scoring methods have tried to predict an accurate measure of life, but have fallen short, as they are based on a patient's physiology at the time of injury.
Before now, Majercik said, there has been no way to model a patient's pre-injury physiology.
"A person's health status prior to an accident plays a huge role in how you recover from a traumatic incident," she said, adding that the score puts doctors one step closer to really being able to make a difference in saving patient lives.
The finding and resulting scores won't, however, change how a patient is treated if they're nearer to death than others, Majercik said.
"Generally, as physicians, the patients who are going to die immediately aren't so much a surprise. We'll know by looking at how much blood they've lost and other things," she said.
Surgeons typically look at four telling components of a full blood test, including the white blood cell count; hemoglobin and hematocrit; and platelets, which can indicate the presence of infection or inflammation, anemia or clotting abilities, respectively. Other factors are overlooked in the acute setting, even though they are part of the results on the screen.
"Some risk factors will be already apparent for physicians, but others aren't intuitive," Horne said.11 comments on this story
A trauma patient, for example, may look completely healthy apart from his or her injury, but if the risk score uncovers an irregular red blood cell distribution, or the fact they have anemia, it could increase that person's risk of dying.
"It's a standard part of the CBC test, but it's not usually taken into consideration when treating a patient with injuries," Horne said. "Based on the findings of our research, it's something that should be looked at as part of the care plan model."
The idea could lead to new treatment approaches, in addition to giving physicians a better understanding of a patient's condition for more effective long-term care, which is a priority set forth in the Affordable Care Act.