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

Effect of different factors on predicting patient mortality beyond the NACA classification: a multivariate analysis of more than 2,000 polytrauma patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of different factors on predicting patient mortality beyond the NACA classification: a multivariate analysis of more than 2,000 polytrauma patients Isabel Scala, Martin Riegger, Alessandro Bensa, Andrea Stefano Monteleone, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7107823/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Dec, 2025 Read the published version in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine → Version 1 posted 9 You are reading this latest preprint version Abstract 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), reanimation (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 reanimation, 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 polytrauma registry NACA score emergency medicine GCS ISS Figures Figure 1 BACKGROUND Traumatic accidents are a leading cause of death, disability, and decreased quality of life worldwide, ranking among the top three causes of death in individuals up to 44 years old.[ 1 ] In particular, polytrauma continue to pose significant challenges for both treatment and prognosis.[ 2 , 3 ] The lack of a standardized classification was a major challenge in guiding the therapeutic decisions when managing polytrauma patients, especially during the earliest phases of patient’s admission at the hospital.[ 4 ] An early and accurate classification system of polytraumatized patients is crucial for assessing injury severity and estimating mortality risk. Accordingly, over the years the definition of polytrauma evolved, shifting from a purely anatomical-based definition to a more specific framework that additionally integrated the presence of other abnormal clinical parameters.[ 5 – 8 ] In the prehospital setting, the National Advisory Committee for Aeronautics (NACA) score is now widely used by emergency medical services to assess patients. Originally created for 24h post-admission evaluations, the NACA score was revised in 1980 by Tryba et al. to simplify and expand its use in the emergency setting for trauma and non-trauma patients.[ 9 ] Several studies demonstrated the validity of the NACA score in predicting mortality in trauma patients.[ 10 – 12 ] NACA scores of 4 and 5 are among the most frequently assigned classifications, indicating severe and potentially life-threatening injuries. However, these two categories are rather broad and may have overlapping clinical presentations on one side, and on the other hand a large variety of different conditions within each level. The ability to accurately assess the patient condition is paramount as it can directly influence triage decisions, prehospital interventions, and early hospital management. However, the factors having the greatest impact on patients’ overall outcome and on the mortality risk in these patients remain a subject of debate in the current literature, thus impairing optimal trauma care strategies and, in the end, management and survival of these complex patients. This study’s aim was to investigate a large cohort of NACA 4 and NACA 5 trauma patients and to quantify the impact of individual factors on the mortality risk. MATERIALS AND METHODS Study design and population This study was conducted at the Lugano Regional Hospital (Switzerland), a Level I Trauma Center, after the approval of the local Ethical Committee (prot 2024 − 00236 CE 4536). This research is based on data obtained from the local polytrauma registry affiliated to the National Swiss Trauma Registry (STR)[ 13 ], which consists in prospectively collected data from trauma patients including parameters ranging from pre- and hospital setting until patient’s discharge. Patients of all ages admitted to the emergency department (ED) at the Lugano Regional Hospital between January 2015 and December 2023 with a NACA score of 4 or 5 were included in this analysis. Extracted patient parameters included age, mechanism of injury, initial NACA score, prehospital variables (Glasgow Coma Scale (GCS), reanimation, intubation, administration of vasoactive drugs and fluids), hospital variables (GCS ED, laboratory values ED, intensive care unit (ICU) stay, mechanical ventilation), calculated Injury Severity Score (ISS), and patient diagnoses. The survival at discharge was defined as outcome measurement. Patient assessment In the prehospital setting the NACA score and the GCS were the first tools used to describe and assess the status of polytraumatized patients by emergency medical staff. The NACA score classifies patients on a scale from 0–7 (Table 1 ) based on the severity of their injuries and their needs of medical support.[ 10 – 12 ] The GCS evaluates patients’ neurological responses according to the sum of 3 qualities (eye-opening, motor and verbal responses) to quantify their responsiveness on a scale of 3–15 and to determine a possible impaired neurological status.[ 14 ] Table 1 National Advisory Committee on Aeronautics (NACA) score [ 9 ] and Abbreviated Injury Scale (AIS)[ 15 ] NACA score Description AIS Description NACA 0 No injury or disease AIS 0 No injury NACA 1 Injuries/diseases without need for acute physician care AIS 1 Minor NACA 2 Injuries/diseases requiring examination and therapy by physician, but admission not indicated AIS 2 Moderate NACA 3 Injuries/diseases without acute threat to life but hospital admission required AIS 3 Serious, not life-threatening NACA 4 Injuries/diseases that can lead to deterioration of vital signs AIS 4 Serious, life- threatening NACA 5 Injuries/diseases with acute threat to life AIS 5 Critical, survival unknown NACA 6 Injuries/diseases transported after successful resuscitation AIS 6 Maximum, lethal NACA 7 Lethal injuries or diseases (with or without resuscitation attempt) - - The Abbreviated Injury Scale (AIS) is assigned to each patient with multiple injuries. For each of the six defined body regions (head/neck, face, chest, abdomen, extremities/pelvis, and external), the highest AIS score is recorded. The three highest AIS scores are then squared and summed to calculate the Injury Severity Score (ISS), which ranges from 0 to 75. If at least one injury is classified as AIS 6, the ISS is automatically set to 75. [ 15 ] The severity of the summary of all sustained injuries in a trauma patient is estimated calculating the ISS, based on the Abbreviated Injury Scale (AIS) ranging from 0–6 (Table 1 ). A cut-off of ISS ≥ 16 is considered a polytrauma.[ 6 ] As an additional parameter for the description of trauma severity, the number of injured body regions was assessed based on the list of patients’ diagnoses. The following eleven different regions were defined: head, face, neck, cervical spine, thoracic spine, lumbar spine, thorax, abdomen, upper extremity, lower extremity and pelvis, external (skin) and thermal injuries. A cut-off of ≥ 2 involved regions regardless of the number of injuries within one region was set to detect more severely injured patients. Statistics Statistical analyses were performed using the statistical software STATA (version 17, StatCorp. LP, College Station, TX, USA). Descriptive statistics were used to describe differences in patient characteristics depending on if they were survivors or non-survivors. Continuous variables were reported as mean and standard deviation (SD). Qualitative variables were expressed as absolute and relative frequencies. Qualitative variables were analysed with the Pearson chi squared test or two-sided Fisher exact test. The parametric two-sample t-test (Student’s t-test) and the nonparametric two sample Wilcoxon rank-sum test (Mann Whitney test) were used to analyse continuous variables. Subsequently, univariate logistic regression was performed to determine which variables individually represented a risk factor for mortality. For the identification of which previously established risk factors for mortality acted as independent predictors, a multivariate logistic regression analysis was performed. Odds ratios (OR) > 1 indicate a higher risk of mortality with the presence or increase of a parameter, while an odds ratio (OR) < 1 expresses an increased risk of mortality for the absence or reduction of a parameter. Every step of the statistical analysis was conducted for all included patients together and for the two subgroups of patients with NACA 4 and NACA 5 separately. Missing values were left out of the analysis. A significance level of 5% (p < 0.05) was considered statistically significant. RESULTS A total of 2,152 trauma patients were enrolled in the study, with 78.3% classified as NACA 4 and 21.7% as NACA 5. Among them, 2,031 patients survived (94.4%), while 121 patients (5.6%) died during hospitalization. The patient characteristics including all analyzed parameters are shown in Table 2 divided into two subgroups according to the NACA severity. Table 2 Patients’ characteristics NACA 4 (N = 1,684, 78.3%) NACA 5 (N = 468, 21.7%) Survivors (N = 1,643, 97.6%) Non-survivors (N = 41, 2.4%) Survivors (N = 388, 82.9%) Non-survivors (N = 80, 17.1%) Age (mean ± SD, years) 53.4 ± 22.7 (N = 1630) 86.0 ± 10.7 (N = 41) 51.0 ± 20.7 (N = 385) 72.8 ± 17.8 (N = 79) Injury mechanism (N, %) fall 3 m: 267 (16.3%), other fall: 34 (2.1%), pedestrian road accident: 50 (3.0%), road accident: 543 (33.0%), other a : 223 (13.6%) fall 3 m: 9 (22.0%), other fall: 0 (0%), pedestrian road accident: 0 (0%), road accident: 3 (7.3%), other a : 1 (2.4%) fall 3 m: 87 (22.4%), other fall: 6 (1.5%), pedestrian road accident: 20 (5.2%), road accident: 137 (35.3%), other a : 60 (15.3%) fall 3 m: 17 (21.3%), other fall: 4 (5.0%), pedestrian road accident: 2 (2.5%), road accident: 10 (12.5%), other a : 7 (8.8%) GCS prehospital (mean ± SD) 14.3 ± 1.5 (N = 1613) 12.8 ± 2.7 (N = 41) 10.9 ± 4.4 (N = 385) 7.0 ± 4.1 (N = 79) Reanimation prehospital (N, %) no: 1,637 (99.7%), yes: 5 (0.3%) no: 40 (97.6%), yes: 1 (2.4%) no: 383 (98.7%), yes: 5 (1.3%) no: 77 (96.3%), yes: 3 (3.7%) Intubation prehospital (N, %) no: 1,626 (99.0%), yes: 16 (1%) no: 39 (95.1%), yes: 2 (4.9%) no: 242 (62.4%), yes: 146 (37.6%) no: 22 (27.5%), yes: 58 (72.5%) Vasoactive drugs prehospital (N, %) no: 1,459 (99.1%), yes: 13 (0.9%) no: 36 (97.3%), yes: 1 (2.7%) no: 298 (86.4%), yes: 47 (13.6%) no: 47 (70.2%), yes: 20 (29.8%) Fluids prehospital (N, %, mL) 0–500: 1,295 (83.4%), 501–1000: 215 (13.8%), 1,001–1,500: 32 (2.1%), >1,500: 11 (0.7%) 0–500: 38 (92.7%), 501–1,000: 3 (7.3%), 1,001–1,500: 0 (0%), >1,500: 0 (0%) 0–500: 195 (52.7%), 501–1,000: 110 (29.7%), 1,001–1,500: 47 (12.7%), >1,500: 18 (4.9%) 0–500: 44 (58.7%), 501–1,000: 22 (29.3%), 1,001–1,500: 2 (2.67%), >1,500: 7 (9.3%) GCS at ER (mean ± SD) 14.3 ± 1.7 (N = 1,635) 11.6 ± 3.4 (N = 41) 9.4 ± 5.5 (N = 386) 4.7 ± 3.7 (N = 80) Hemoglobin at ER (mean ± SD, g/dL) 13.9 ± 1.8 (N = 1,609) 12.2 ± 2.1 (N = 41) 13.1 ± 2.2 (N = 386) 11.9 ± 2.4 (N = 77) Thrombocytes at ER (mean ± SD, 10 9 /L) 243.9 ± 73.4 (N = 1,607) 211.1 ± 71.3 (N = 41) 239 ± 77.6 (N = 386) 197.8 ± 74.2 (N = 75) INR at ER (mean ± SD) 1.1 ± 0.3 (N = 1,564) 1.3 ± 0.7 (N = 39) 1.1 ± 0.3 (N = 384) 1.4 ± 0.7 (N = 71) ICU stay no: 1,225 (74.6%), yes: 418 (25.4%) no: 23 (56.1%), yes: 18 (43.9%) no: 109 (28.1%), yes: 279 (71.9%) no: 25 (31.3%), yes: 55 (68.7%) Mechanical ventilation no: 1,411 (91.1%), yes: 138 (8.9%) no: 26 (63.4%), yes: 15 (36.6%) no: 161 (42.5%), yes: 218 (57.5%) no: 26 (32.5%), yes: 54 (67.5%) ISS ≥ 16 (N, %) no: 1,331 (81.0%), yes: 312 (19.0%) no: 19 (46.3%), yes: 22 (53.7%) no: 200 (51.6%), yes: 188 (48.4%) no: 9 (11.3%), yes: 71 (88.7%) ≥ 2 injured regions b (N, %) no: 576 (35.1%), yes: 1,067 (64.9%) no: 15 (36.6%), yes: 26 (63.4%) no: 106 (27.3%), yes: 282 (72.7%) no: 32 (40.0%), yes: 48 (60.0%) Abbreviations: NACA: National Advisory Committee for Aeronautics score, GCS: Glasgow Coma Scale, ER: Emergency Room, INR: International Normalized Ratio, ICU: intensive care unit, ISS: injury Severity Score, N: number of patients, SD: standard deviation, m: meters, mL: milliliters, g/dL: grams/deciliter, L: liter , a Other includes: shooting, stabbing, hitting, explosion, avalanche and unknown , b Possible injured regions: head, face, neck, cervical spine, thoracic spine, lumbar spine, thorax, abdomen, upper extremity, lower extremity and pelvis, external (skin) and thermal injuries. Patients’ characteristics: survivors vs non-survivors The results of the comparative analysis between survivors and non-survivors, including all patients as well as the NACA 4 and NACA 5 subgroups evaluated separately, are presented in Fig. 1 . Significant differences (p < 0.001) were found in all prehospital and hospital variables, as well as within “age”. In both NACA 4 and NACA 5 subgroups, most parameters were statistically significant. Key variables included age, GCS (prehospital and hospital), prehospital intubation, hemoglobin, thrombocyte count, and INR (all p < 0.0001). In the NACA 4 subgroup, prehospital resuscitation (p = 0.024), ICU admission (p = 0.008), and mechanical ventilation (p < 0.0001) differed significantly between survivors and non-survivors. In the NACA 5 subgroup, prehospital use of vasoactive drugs (p = 0.001) and fluids (p = 0.040), as well as injuries in ≥ 2 regions (p = 0.024) differed significantly between survivors and non-survivors. A significant difference was identified for the injury severity defined by an ISS ≥ 16 between survivors and non-survivors both in the main analysis and in the two sub-analyses (p < 0.0001). Univariate analysis For the entire patient cohort, age and all analyzed prehospital, and hospital collected variables were identified as significant risk factors influencing mortality (Table 3 ). Higher age, higher NACA score, prehospital resuscitation, intubation, administration of fluids or vasoactive drugs, need for ICU admission, mechanical ventilation, elevated INR levels were all associated with higher mortality risk (Table 3 ). Lower prehospital and hospital GCS, as well as reduced hemoglobin and thrombocyte levels, were also significant predictors for increased mortality risk. Additionally, the severity of sustained injuries, as indicated by an ISS ≥ 16 was also identified as a significant predictor of mortality. Subgroup analysis confirmed significant associations with most variables for both NACA 4 and NACA 5 subgroups, particularly age, prehospital and hospital GCS, prehospital intubation, laboratory values – including hemoglobin and thrombocytes – and ISS ≥ 16. Some variables showed subgroup-specific effects: in the NACA 4 group, the need for ICU admission ( OR 2.29, p = 0.009) and use of mechanical ventilation ( OR 5.90, p < 0.0001) were significantly associated with mortality risk. In the NACA 5 subgroup, prehospital administration of vasoactive drugs ( OR 2.70, p = 0.001), fluids ( OR 0.19, p = 0.024), and sustaining injuries in ≥ 2 anatomical regions ( OR 0.56, p = 0.025), were significant predictors of mortality. Table 3 Univariate logistic regression for predictors of mortality OR a All patients p value b OR a NACA 4 p value b OR a NACA 5 p value b Age 1.07 (1.05–1.08) p < 0.0001* 1.14 (1.10–1.18) p < 0.0001* 1.06 (1.05–1.08) p < 0.0001* NACA score 8.26 (5.58–12.23) p < 0.0001* - - - - GCS prehospital 0.76 (0.73–0.79) p < 0.0001* 0.78 (0.71–0.86) p < 0.0001* 0.83 (0.78–0.88) p < 0.0001* Reanimation prehospital 6.91 (2.13–22.35) p = 0.001* 8.19 (0.93–71.67) p = 0.058 2.98 (0.70-12.75) p = 0.140 Intubation prehospital 11.34 (7.67–16.77) p < 0.0001* 5.21 (1.16–23.45) p = 0.031* 4.37 (2.57–7.44) p < 0.0001* Vasoactive drugs prehospital 7.41 (4.30-12.76) p < 0.0001* 3.12 (0.40-24.48) p = 0.279 2.70 (1.47–4.95) p = 0.001* Fluids prehospital c 4.39 (1.87–10.31) p = 0.001* 0.48 (0.145–1.55) p = 0.219 0.19 (0.04–0.81) p = 0.024* GCS at ER 0.77 (0.74–0.80) p < 0.0001* 0.74 (0.69–0.80) p < 0.0001* 0.82 (0.77–0.88) p < 0.0001* Hemoglobin at ER 0.70 (0.64–0.76) p < 0.0001* 0.68 (0.60–0.78) p < 0.0001* 0.81 (0.73–0.89) p < 0.0001* Thrombocytes at ER 0.99 (0.987–0.993) p < 0.0001* 0.99 (0.987-1.0) p = 0.003* 0.99 (0.987–0.995) p < 0.0001* INR at ER 2.90 (2.13–3.93) p < 0.0001* 2.40 (1.55–3.83) p < 0.0001* 4.45 (2.27–8.74) p < 0.0001* ICU stay 2.91 (2.0-4.24) p < 0.0001* 2.29 (1.23–4.29) p = 0.009* 0.86 (0.51–1.45) p = 0.570 Mechanical ventilation 5.86 (4.02–8.55) p < 0.0001* 5.90 (3.05–11.4) p < 0.0001* 1.53 (0.92–2.56) p = 0.100 ISS ≥ 16 10.17 (6.59–15.70) p < 0.0001* 4.94 (2.64–9.24) p < 0.0001* 8.39 (4.08–17.27) p < 0.0001* ≥ 2 injured regions 0.80 (0.55–1.16) p = 0.236 0.94 (0.49–1.78) p = 0.840 0.56 (0.34–0.93) p = 0.025* Abbreviations: NACA: National Advisory Committee for Aeronautics score, GCS: Glasgow Coma Scale, ER: Emergency Room, INR: International Normalized Ratio, ICU: intensive care unit, ISS: injury Severity Score, OR: odds ratio , a OR and 95%-CI in brackets, OR > 1: death more likely if variable is higher or present, OR < 1: death more likely if variable is lower or absent , b significance level *p < 0.05 , c different groups were analysed against each other, most significant association is indicated. Multivariate analysis The multivariate analysis of the prehospital variables (Table 4 ) showed that age ( OR 1.11, p < 0.0001), NACA score ( OR 2.96, p = 0.002), GCS ( OR 0.78, p < 0.0001), reanimation ( OR 7.22, p = 0.039), and administration of vasoactive drugs ( OR 2.38, p = 0.037) were statistically significant independent risk factors for all included patients, while intubation and administration of liquids were not. In the NACA 4 subgroup analysis only age ( OR 1.13, p < 0.0001) and GCS ( OR 0.69, p < 0.0001) emerged as statistically significant predictors of mortality. In the NACA 5 patients age ( OR 1.09, p < 0.0001), GCS ( OR 0.82, p < 0.0001), and administration of vasoactive drugs ( OR 2.4, p = 0.039) emerged as statistically significant predictors of mortality. Table 4 Multivariate logistic regression for predictors of mortality with prehospital variables OR a All patients (N = 1,818) p value b OR a NACA 4 (N = 1,427) p value b OR a NACA 5 (N = 391) p value b Age 1.11 (1.08–1.13) p < 0.0001* 1.13 (1.09–1.18) p < 0.0001* 1.09 (1.06–1.12) p < 0.0001* NACA score 2.96 (1.48–5.93) p = 0.002* - - - - GCS prehospital 0.78 (0.72–0.85) p < 0.0001* 0.69 (0.58–0.81) p < 0.0001* 0.82 (0.75–0.90) p < 0.0001* Reanimation prehospital 7.22 (1.11-47.00) p = 0.039* 14.02 (0.90-218.3) p = 0.059 6.02 (0.38–94.57) p = 0.202 Intubation prehospital 1.56 (0.68–3.53) p = 0.292 0.58 (0.03–10.46) p = 0.711 1.81 (0.78–4.21) p = 0.167 Vasoactive drugs prehospital 2.38 (1.05–5.37) p = 0.037* 0.47 (0.01–19.90) p = 0.696 2.40 (1.05–5.50) p = 0.039* Fluids prehospital 0.84 (0.55–1.28) p = 0.422 0.70 (0.22-2-27) p = 0.556 0.87 (0.56–1.36) p = 0.550 Abbreviations: NACA: National Advisory Committee for Aeronautics score, GCS: Glasgow Coma Scale, OR: odds ratio , a OR and 95%-CI in brackets, OR > 1: death more likely if variable is higher or present, OR < 1: death more likely if variable is lower or absent , b significance level *p < 0.05. DISCUSSION The main finding of this study is that different factors can influence the mortality risk beyond the mere NACA 4 and 5 classification of polytrauma patients, including reanimation, administration of vasoactive drugs, GCS, and age. Previous studies investigated the NACA score showing good correlations between the NACA score and survival as well as a strong ability to predict mortality for trauma patients.[ 11 , 12 ] This study builds upon these findings, confirming such results for NACA 4 and NACA 5 patients. The univariate logistic regression analysis revealed a significant difference in NACA score between survivors and non-survivors. By including all prehospital variables, this study demonstrated that the distinction between NACA 4 and NACA 5 was associated with an almost 300% increase in mortality risk. Hence, it can be regarded as a valid score for the early prehospital assessment of mortality in trauma patients. This study found significant differences between survivors and non-survivors in both prehospital and hospital factors. In addition to the NACA score, key mortality predictors included age, prehospital and hospital GCS, need for advanced interventions (e.g., resuscitation, intubation, vasoactive drugs, fluids), ICU admission, mechanical ventilation, specific laboratory values, and ISS ≥ 16. In the multivariate analysis, age, GCS, and NACA score emerged as the strongest independent predictors of mortality, highlighting their value in guiding early management before hospital admission. Older age and low GCS have been previously identified as independent mortality predictors in trauma patients and were therefore added to various definitions and scores related to trauma to increase their predictive power on survival.[ 6 , 7 , 16 – 18 ] This study confirmed both factors as significant predictors in univariate and multivariate analyses in all patient groups. Several other risk factors have been evaluated for their impact on mortality in polytrauma patients. Among these, traumatic cardiac arrest is recognized as both rare and highly fatal. Seewald et al. reported 4% of cardiac arrests stemmed from major trauma, with a 95% mortality rate.[ 19 ] The present study specifically analyzed prehospital reanimation in trauma patients as a risk factor for mortality and found significant results when including all NACA 4 and NACA 5 patients in the multivariate analysis, indicating that the necessity of prehospital reanimation has the biggest impact on mortality. Prehospital intubation was another significant mortality risk factor identified by the univariate analysis, both in the main analysis and in the NACA 4 and NACA 5 sub-analyses. However, this association did not retain statistical significance in the multivariate analysis. Previous investigations reported mixed findings regarding the impact of prehospital intubation and focused primarily on the comparison between prehospital and hospital intubation without examining prehospital intubation as an independent risk factor for mortality.[ 20 – 22 ] Additionally, they focused on patients with isolated traumatic brain injury (TBI) rather than on the general polytraumatized population. The findings of the present study build upon these previous results suggesting that prehospital intubation could play a role, albeit not being the most relevant factor influencing mortality in polytrauma patients. Fluids or vasoactive drugs are often used for prehospital hemodynamic support in polytrauma patients. The univariate analysis showed that an increased administration of fluids was associated with an increased mortality in all patients combined. However, counterintuitively a decreased risk of death was found for the separate analysis of the NACA 5 subgroup. This apparent contradiction may reflect the heterogeneity between NACA 4 and 5 patients, with fluid use potentially indicating greater injury severity in the former, and timely intervention in the latter.[ 18 ] The administration of a greater amount of fluids may be a sign of earlier recognition of hemodynamic instability and earlier treatment leading to increased survival. The administration of vasoactive drugs was significantly associated with increased mortality both overall and within the NACA 5 subgroup, aligning with previous studies.[ 23 , 24 ] Multivariate analysis showed that fluid administration was not an independent predictor of mortality, while vasoactive drug use significantly increased mortality in both the overall cohort and the NACA 5 subgroup. These findings support the NACA score’s ability to distinguish between patients at immediate (NACA 5) and potential (NACA 4) risk of life-threatening conditions. Concerning the parameters collected in the ED, parameters such as low GCS, hemoglobin, thrombocyte levels, and coagulopathy were confirmed as significant mortality risk predictors, in line with previous studies.[ 12 , 25 – 27 ] Conversely, the impact of ICU admission and mechanical ventilation with its influence on mortality in polytrauma patients is less well studied, as most prior research focused solely on ICU-admitted populations.[ 28 – 30 ] This current study showed a significant association with mortality in the overall cohort and the NACA 4 subgroup, while the NACA 5 subgroup did not indicate an association between ICU admission and mechanical ventilation with patients’ survival. This may reflect a possible confounding factor, as more severely injured NACA 5 patients may have died before ICU admission or before mechanical ventilation could be initiated and registry documented. The assessment of injury severity measured by an ISS ≥ 16 is another widely acknowledged as a strong predictor of mortality. Current findings reinforce this association in both NACA 4 and NACA 5 subgroups. However, the injury distribution analysis showed that involvement of multiple regions was significantly associated with survival only in NACA 5. The Univariate analysis demonstrated a lower mortality risk in patients with multiple injured regions, suggesting that certain isolated injuries, such as severe traumatic brain injury or major thoracic trauma, may carry a disproportionately higher mortality risk than multi-region injuries of moderate severity. Similarly, Paffrath et al. reported lower mortality (18.7%) in patients with multiple injuries versus 20.4% overall and 31% in monotrauma cases (AIS 4 or 5), highlighting the need to integrate physiological criteria into major trauma definitions to improve mortality risk stratification. [ 7 ] This study presents several limitations that must be noted. Its registry-based design may have introduced biases due to missing or inconsistent data, particularly regarding vital signs like arterial blood pressure and laboratory results. The absence of information on comorbidities and systemic inflammatory response (SIRS) criteria further limits the analysis. While the multivariate analysis helped providing a control of confounding bias, residual confounding bias could not be excluded. Despite these limitations, the study offers valuable insights into mortality risk factors in polytrauma patients. A major strength lies in the large and diverse cohort, enabling a broad evaluation of predictors across different trauma severities and care settings. The inclusion of extensive prehospital and hospital variables, along with both univariate and multivariate analyses, enhances the reliability and depth of the findings. Analyzing NACA 4 and NACA 5 subgroups separately revealed meaningful differences in mortality predictors, highlighting the importance of tailored clinical approaches. The findings suggest that factors such as reanimation, vasoactive drug use, GCS, and age significantly impact mortality, beyond the NACA classification alone. Recognizing these parameters early may support more targeted interventions. Overall, this study contributes to the ongoing optimization of polytrauma care. Improvements in prehospital response, early injury recognition, and trauma system organization are key to enhancing the outcome and the survival rate of these patients. Future prospective studies with standardized clinical data and long-term outcomes are needed to better understand how injury severity, interventions, and individual patient factors interact in shaping prognosis. Abbreviations AIS Abbreviated. Injury Scale ED Emergency department ER Emergency room GCS Glasgow Coma Scale ICU Intensive care unit INR International Normalized Ratio ISS Injury Severity Score N Number of patients NACA National Advisory Committee for Aeronautics OR Odds ratio SD Standard deviation SIRS Systemic inflammatory response STR Swiss Trauma Registry TBI Traumatic Brain Injury Declarations Ethics approval and consent to participate: The study protocol was approved by the local cantonal ethics committee of the Canton of Tessin, Switzerland (prot 2024-00236 CE 4536). Consent for publication: Not applicable. Availability of data and materials: Data was extracted from the Local Polytrauma Registry affiliated to the Swiss Trauma Registry. Competing interests: The authors declare that they have no competing interests. Funding: No Funding. Author’s contributions: IS, MR and GF designed the study. IS, MR, AB and GF analysed the data. IS drafted the manuscript. MR, AB, ASM, PIF and GF reviewed the manuscript. All authors read and approved the final manuscript Acknowledgement: The authors thank Prof. Dr. med. Alberto Pagnamenta for his work in the statistical analysis. References World Health Organization. Injuries and violence: the facts 2014 . World Health Organization 2014. https://iris.who.int/handle/10665/149798 (accessed 4 Feb2025). Bouillon B, Neugebauer E. Outcome after polytrauma. Langenbecks Arch Surg 1998; 383 :228–34. Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2023; 49 :747–61. Butcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. Injury 2009; 40 Suppl 4 :S12-22. Butcher NE, D’Este C, Balogh ZJ. The quest for a universal definition of polytrauma: A trauma registry-based validation study. Journal of Trauma and Acute Care Surgery 2014; 77 :620. Pape H-C, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, et al. The definition of polytrauma revisited: An international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg 2014; 77 :780–6. Paffrath T, Lefering R, Flohé S. How to define severely injured patients?—An Injury Severity Score (ISS) based approach alone is not sufficient. Injury 2014; 45 :S64–9. Frenzel S, Krenn P, Heinz T, Negrin LL. Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017; 25 :87. Tryba. Klassifizierung von Erkrankungen und Verletzungen im Notarztrettungssystem. Notfallmedizin 1980; 8:725–727. Weiss M, Bernoulli L, Zollinger A. Der NACA-IndexAussagekraft und Stellenwert des modifizierten NACA-Indexes in der präklinischen Schweregraderfassung von Unfallpatienten. Anaesthesist 2001; 50 :150–4. Darioli V, Taffé P, Carron P-N, Dami F, Vallotton L, Yersin B, et al. Evaluation of the discriminative performance of the prehospital National Advisory Committee for Aeronautics score regarding 48-h mortality. European Journal of Emergency Medicine 2019; 26 :366. Fiore PI, Monteleone AS, Müller J, Filardo G, Candrian C, Riegger M. The NACA score predicts mortality in polytrauma patients before hospital admission: a registry-based study. Scand J Trauma Resusc Emerg Med 2024; 32 :116. Swiss Trauma Board. Swiss Trauma Registry (STR). https://www.swisstraumaboard.ch/ (accessed 11 Jun2024). Teasdale G, Jennett B. ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale. The Lancet 1974; 304 :81–4. Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14 :187–96. Rau C-S, Wu S-C, Kuo P-J, Chen Y-C, Chien P-C, Hsieh H-Y, et al. Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach. Int J Environ Res Public Health 2017; 14 :1045. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Critical Care 2011; 15 :R191. da Costa LGV, Carmona MJC, Malbouisson LM, Rizoli S, Rocha-Filho JA, Cardoso RG, et al. Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study. Clinics (Sao Paulo) 2017; 72 :461–8. Seewald S, Wnent J, Gräsner J-T, Tjelmeland I, Fischer M, Bohn A, et al. Survival after traumatic cardiac arrest is possible—a comparison of German patient-registries. BMC Emergency Medicine 2022; 22 :158. Denninghoff KR, Nuño T, Pauls Q, Yeatts SD, Silbergleit R, Palesch YY, et al. Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT III. Prehospital Emergency Care 2017; 21 :539–44. Fevang E, Perkins Z, Lockey D, Jeppesen E, Lossius HM. A systematic review and meta-analysis comparing mortality in pre-hospital tracheal intubation to emergency department intubation in trauma patients. Critical Care 2017; 21 :192. Renberg M, Dahlberg M, Gellerfors M, Rostami E, Günther M. Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2023; 31 :85. Sperry JL, Minei JP, Frankel HL, West MA, Harbrecht BG, Moore EE, et al. Early use of vasopressors after injury: caution before constriction. J Trauma 2008; 64 :9–14. Hylands M, Toma A, Beaudoin N, Frenette AJ, D’Aragon F, Belley-Côté É, et al. Early vasopressor use following traumatic injury: a systematic review. BMJ Open 2017; 7 :e017559. de Vries R, Reininga IHF, de Graaf MW, Heineman E, El Moumni M, Wendt KW. Older polytrauma: Mortality and complications. Injury 2019; 50 :1440–7. Mica L, Rufibach K, Keel M, Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. J Trauma Manag Outcomes 2013; 7 :6. Jin WYY, Jeong JH, Kim DH, Kim TY, Kang C, Lee SH, et al. Factors predicting the early mortality of trauma patients. Ulus Travma Acil Cerrahi Derg 2018; 24 :532–8. Böhmer AB, Just KS, Lefering R, Paffrath T, Bouillon B, Joppich R, et al. Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases. Critical Care 2014; 18 :R143. Prin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Injury Epidemiology 2016; 3 :18. Papadimitriou-Olivgeris M, Panteli E, Koutsileou K, Boulovana M, Zotou A, Marangos M, et al. Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study☆. Brazilian Journal of Anesthesiology (English Edition) 2021; 71 :23–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Dec, 2025 Read the published version in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine → Version 1 posted Editorial decision: Revision requested 22 Aug, 2025 Reviews received at journal 17 Aug, 2025 Reviews received at journal 12 Aug, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviewers agreed at journal 10 Aug, 2025 Reviewers invited by journal 10 Aug, 2025 Editor assigned by journal 14 Jul, 2025 Submission checks completed at journal 14 Jul, 2025 First submitted to journal 12 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7107823","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":499366380,"identity":"64ea4a08-a5b8-4243-8494-ea16ee95eb50","order_by":0,"name":"Isabel Scala","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACNjAqADGZGxg+MDDwgBFhLQYgJmMD4wxitDAga2GGKCaghY//8LMHHwwY7PnbDzZ+tm2rk2FgP3sAvxUSaeaGMwwYEmecSWyWzm07zMPAk5dAQAuDmTSPAUMCUFcDUMsBHgYJHgP8WviPf5P+A3SYAf/D5t+WbXVEaGHIMZMGep9xg0RimzRjGzMRWiRyyg17DCQSZ9x42GbZc+4wDxtPDn4t8v3Htz34UWFjz9+ffPjGj7I6e372M/i1QIEEslNHwSgYBaNgFFAMAMqnN93mEMWkAAAAAElFTkSuQmCC","orcid":"","institution":"University of Lugano","correspondingAuthor":true,"prefix":"","firstName":"Isabel","middleName":"","lastName":"Scala","suffix":""},{"id":499366382,"identity":"bb8a3f4d-b46b-4219-b7a7-02ece8ca5f75","order_by":1,"name":"Martin Riegger","email":"","orcid":"","institution":"EOC","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"","lastName":"Riegger","suffix":""},{"id":499366383,"identity":"900778da-91b6-49c9-bf19-ed31755e428c","order_by":2,"name":"Alessandro Bensa","email":"","orcid":"","institution":"EOC","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Bensa","suffix":""},{"id":499366384,"identity":"92c4933d-7745-442a-995c-ab14b1c003f2","order_by":3,"name":"Andrea Stefano Monteleone","email":"","orcid":"","institution":"EOC","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"Stefano","lastName":"Monteleone","suffix":""},{"id":499366385,"identity":"edb96e8e-2e02-4398-8ca5-d1e051f5c50d","order_by":4,"name":"Paolo Ivan Fiore","email":"","orcid":"","institution":"EOC","correspondingAuthor":false,"prefix":"","firstName":"Paolo","middleName":"Ivan","lastName":"Fiore","suffix":""},{"id":499366387,"identity":"b29c749b-9afb-4925-9787-7e4d0d4276ed","order_by":5,"name":"Christian Candrian","email":"","orcid":"","institution":"EOC","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Candrian","suffix":""},{"id":499366390,"identity":"268909c4-d903-4472-8198-c8f729f4b7c2","order_by":6,"name":"Giuseppe Filadro","email":"","orcid":"","institution":"EOC","correspondingAuthor":false,"prefix":"","firstName":"Giuseppe","middleName":"","lastName":"Filadro","suffix":""}],"badges":[],"createdAt":"2025-07-12 11:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7107823/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7107823/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13049-025-01511-2","type":"published","date":"2025-12-29T15:57:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89258269,"identity":"09a591ec-78ec-44c5-8c34-82360dc192cd","added_by":"auto","created_at":"2025-08-18 06:20:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":335692,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of survivors vs non-survivors\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7107823/v1/f7b156c75dec8c6de39568f2.png"},{"id":99545352,"identity":"56356af3-02e5-42da-8622-51ffb7017af6","added_by":"auto","created_at":"2026-01-05 16:06:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1664995,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7107823/v1/d0c079dc-b367-4d70-b6c2-0b3a78f50a70.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of different factors on predicting patient mortality beyond the NACA classification: a multivariate analysis of more than 2,000 polytrauma patients","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eTraumatic accidents are a leading cause of death, disability, and decreased quality of life worldwide, ranking among the top three causes of death in individuals up to 44 years old.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In particular, polytrauma continue to pose significant challenges for both treatment and prognosis.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] The lack of a standardized classification was a major challenge in guiding the therapeutic decisions when managing polytrauma patients, especially during the earliest phases of patient\u0026rsquo;s admission at the hospital.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] An early and accurate classification system of polytraumatized patients is crucial for assessing injury severity and estimating mortality risk. Accordingly, over the years the definition of polytrauma evolved, shifting from a purely anatomical-based definition to a more specific framework that additionally integrated the presence of other abnormal clinical parameters.[\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eIn the prehospital setting, the National Advisory Committee for Aeronautics (NACA) score is now widely used by emergency medical services to assess patients. Originally created for 24h post-admission evaluations, the NACA score was revised in 1980 by Tryba et al. to simplify and expand its use in the emergency setting for trauma and non-trauma patients.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Several studies demonstrated the validity of the NACA score in predicting mortality in trauma patients.[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] NACA scores of 4 and 5 are among the most frequently assigned classifications, indicating severe and potentially life-threatening injuries. However, these two categories are rather broad and may have overlapping clinical presentations on one side, and on the other hand a large variety of different conditions within each level. The ability to accurately assess the patient condition is paramount as it can directly influence triage decisions, prehospital interventions, and early hospital management. However, the factors having the greatest impact on patients\u0026rsquo; overall outcome and on the mortality risk in these patients remain a subject of debate in the current literature, thus impairing optimal trauma care strategies and, in the end, management and survival of these complex patients.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s aim was to investigate a large cohort of NACA 4 and NACA 5 trauma patients and to quantify the impact of individual factors on the mortality risk.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cb\u003eStudy design and population\u003c/b\u003e\u003c/p\u003e\u003cp\u003e This study was conducted at the Lugano Regional Hospital (Switzerland), a Level I Trauma Center, after the approval of the local Ethical Committee (prot 2024\u0026thinsp;\u0026minus;\u0026thinsp;00236 CE 4536). This research is based on data obtained from the local polytrauma registry affiliated to the National Swiss Trauma Registry (STR)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which consists in prospectively collected data from trauma patients including parameters ranging from pre- and hospital setting until patient\u0026rsquo;s discharge.\u003c/p\u003e\u003cp\u003ePatients of all ages admitted to the emergency department (ED) at the Lugano Regional Hospital between January 2015 and December 2023 with a NACA score of 4 or 5 were included in this analysis. Extracted patient parameters included age, mechanism of injury, initial NACA score, prehospital variables (Glasgow Coma Scale (GCS), reanimation, intubation, administration of vasoactive drugs and fluids), hospital variables (GCS ED, laboratory values ED, intensive care unit (ICU) stay, mechanical ventilation), calculated Injury Severity Score (ISS), and patient diagnoses. The survival at discharge was defined as outcome measurement.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatient assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn the prehospital setting the NACA score and the GCS were the first tools used to describe and assess the status of polytraumatized patients by emergency medical staff. The NACA score classifies patients on a scale from 0\u0026ndash;7 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) based on the severity of their injuries and their needs of medical support.[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] The GCS evaluates patients\u0026rsquo; neurological responses according to the sum of 3 qualities (eye-opening, motor and verbal responses) to quantify their responsiveness on a scale of 3\u0026ndash;15 and to determine a possible impaired neurological status.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNational Advisory Committee on Aeronautics (NACA) score [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and Abbreviated Injury Scale (AIS)[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNACA score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAIS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo injury or disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo injury\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInjuries/diseases without need for acute physician care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMinor\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInjuries/diseases requiring examination and therapy by physician, but admission not indicated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInjuries/diseases without acute threat to life but hospital admission required\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSerious, not life-threatening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInjuries/diseases that can lead to deterioration of vital signs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSerious, life- threatening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInjuries/diseases with acute threat to life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCritical, survival unknown\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInjuries/diseases transported after successful resuscitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAIS 6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaximum, lethal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA 7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLethal injuries or diseases (with or without resuscitation attempt)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eThe Abbreviated Injury Scale (AIS) is assigned to each patient with multiple injuries. For each of the six defined body regions (head/neck, face, chest, abdomen, extremities/pelvis, and external), the highest AIS score is recorded. The three highest AIS scores are then squared and summed to calculate the Injury Severity Score (ISS), which ranges from 0 to 75. If at least one injury is classified as AIS 6, the ISS is automatically set to 75.\u003c/em\u003e [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe severity of the summary of all sustained injuries in a trauma patient is estimated calculating the ISS, based on the Abbreviated Injury Scale (AIS) ranging from 0\u0026ndash;6 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A cut-off of ISS\u0026thinsp;\u0026ge;\u0026thinsp;16 is considered a polytrauma.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eAs an additional parameter for the description of trauma severity, the number of injured body regions was assessed based on the list of patients\u0026rsquo; diagnoses. The following eleven different regions were defined: head, face, neck, cervical spine, thoracic spine, lumbar spine, thorax, abdomen, upper extremity, lower extremity and pelvis, external (skin) and thermal injuries. A cut-off of \u0026ge;\u0026thinsp;2 involved regions regardless of the number of injuries within one region was set to detect more severely injured patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStatistical analyses were performed using the statistical software STATA (version 17, StatCorp. LP, College Station, TX, USA). Descriptive statistics were used to describe differences in patient characteristics depending on if they were survivors or non-survivors. Continuous variables were reported as mean and standard deviation (SD). Qualitative variables were expressed as absolute and relative frequencies. Qualitative variables were analysed with the Pearson chi squared test or two-sided Fisher exact test. The parametric two-sample t-test (Student\u0026rsquo;s t-test) and the nonparametric two sample Wilcoxon rank-sum test (Mann Whitney test) were used to analyse continuous variables. Subsequently, univariate logistic regression was performed to determine which variables individually represented a risk factor for mortality. For the identification of which previously established risk factors for mortality acted as independent predictors, a multivariate logistic regression analysis was performed. Odds ratios (OR)\u0026thinsp;\u0026gt;\u0026thinsp;1 indicate a higher risk of mortality with the presence or increase of a parameter, while an odds ratio (OR)\u0026thinsp;\u0026lt;\u0026thinsp;1 expresses an increased risk of mortality for the absence or reduction of a parameter. Every step of the statistical analysis was conducted for all included patients together and for the two subgroups of patients with NACA 4 and NACA 5 separately. Missing values were left out of the analysis. A significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 2,152 trauma patients were enrolled in the study, with 78.3% classified as NACA 4 and 21.7% as NACA 5. Among them, 2,031 patients survived (94.4%), while 121 patients (5.6%) died during hospitalization. The patient characteristics including all analyzed parameters are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e divided into two subgroups according to the NACA severity.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatients\u0026rsquo; characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNACA 4 (N\u0026thinsp;=\u0026thinsp;1,684, 78.3%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eNACA 5 (N\u0026thinsp;=\u0026thinsp;468, 21.7%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurvivors (N\u0026thinsp;=\u0026thinsp;1,643, 97.6%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-survivors (N\u0026thinsp;=\u0026thinsp;41, 2.4%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSurvivors (N\u0026thinsp;=\u0026thinsp;388, 82.9%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNon-survivors (N\u0026thinsp;=\u0026thinsp;80, 17.1%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (mean \u0026plusmn; SD, years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.4 \u0026plusmn; 22.7 (N\u0026thinsp;=\u0026thinsp;1630)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.0 \u0026plusmn; 10.7 (N\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51.0 \u0026plusmn; 20.7 (N\u0026thinsp;=\u0026thinsp;385)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72.8 \u0026plusmn; 17.8 (N\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInjury mechanism (N, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efall\u0026thinsp;\u0026lt;\u0026thinsp;3 m: 526 (32.0%), fall\u0026thinsp;\u0026gt;\u0026thinsp;3 m: 267 (16.3%), other fall: 34 (2.1%), pedestrian road accident: 50 (3.0%), road accident: 543 (33.0%), other \u003csup\u003ea\u003c/sup\u003e: 223 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003efall\u0026thinsp;\u0026lt;\u0026thinsp;3 m: 28 (68.3%), fall\u0026thinsp;\u0026gt;\u0026thinsp;3 m: 9 (22.0%), other fall: 0 (0%), pedestrian road accident: 0 (0%), road accident: 3 (7.3%), other \u003csup\u003ea\u003c/sup\u003e: 1 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003efall\u0026thinsp;\u0026lt;\u0026thinsp;3 m: 78 (20.1%), fall\u0026thinsp;\u0026gt;\u0026thinsp;3 m: 87 (22.4%), other fall: 6 (1.5%), pedestrian road accident: 20 (5.2%), road accident: 137 (35.3%), other \u003csup\u003ea\u003c/sup\u003e: 60 (15.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003efall\u0026thinsp;\u0026lt;\u0026thinsp;3 m: 40. (50.0%), fall\u0026thinsp;\u0026gt;\u0026thinsp;3 m: 17 (21.3%), other fall: 4 (5.0%), pedestrian road accident: 2 (2.5%), road accident: 10 (12.5%), other \u003csup\u003ea\u003c/sup\u003e: 7 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGCS prehospital (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.3 \u0026plusmn; 1.5 (N\u0026thinsp;=\u0026thinsp;1613)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.8 \u0026plusmn; 2.7 (N\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.9 \u0026plusmn; 4.4 (N\u0026thinsp;=\u0026thinsp;385)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.0 \u0026plusmn; 4.1 (N\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReanimation prehospital (N, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 1,637 (99.7%), yes: 5 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 40 (97.6%), yes: 1 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 383 (98.7%), yes: 5 (1.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 77 (96.3%), yes: 3 (3.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntubation prehospital (N, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 1,626 (99.0%), yes: 16 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 39 (95.1%), yes: 2 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 242 (62.4%), yes: 146 (37.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 22 (27.5%), yes: 58 (72.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVasoactive drugs prehospital (N, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 1,459 (99.1%), yes: 13 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 36 (97.3%), yes: 1 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 298 (86.4%), yes: 47 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 47 (70.2%), yes: 20 (29.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFluids prehospital (N, %, mL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;500: 1,295 (83.4%), 501\u0026ndash;1000: 215 (13.8%), 1,001\u0026ndash;1,500: 32 (2.1%), \u0026gt;1,500: 11 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;500: 38 (92.7%), 501\u0026ndash;1,000: 3 (7.3%), 1,001\u0026ndash;1,500: 0 (0%), \u0026gt;1,500: 0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026ndash;500: 195 (52.7%), 501\u0026ndash;1,000: 110 (29.7%), 1,001\u0026ndash;1,500: 47 (12.7%), \u0026gt;1,500: 18 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u0026ndash;500: 44 (58.7%), 501\u0026ndash;1,000: 22 (29.3%), 1,001\u0026ndash;1,500: 2 (2.67%), \u0026gt;1,500: 7 (9.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGCS at ER (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.3 \u0026plusmn; 1.7 (N\u0026thinsp;=\u0026thinsp;1,635)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.6 \u0026plusmn; 3.4 (N\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.4 \u0026plusmn; 5.5 (N\u0026thinsp;=\u0026thinsp;386)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.7 \u0026plusmn; 3.7 (N\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemoglobin at ER (mean \u0026plusmn; SD, g/dL)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.9 \u0026plusmn; 1.8 (N\u0026thinsp;=\u0026thinsp;1,609)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.2 \u0026plusmn; 2.1 (N\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.1 \u0026plusmn; 2.2 (N\u0026thinsp;=\u0026thinsp;386)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.9 \u0026plusmn; 2.4 (N\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThrombocytes at ER (mean \u0026plusmn; SD, 10\u003c/b\u003e\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e243.9 \u0026plusmn; 73.4 (N\u0026thinsp;=\u0026thinsp;1,607)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e211.1 \u0026plusmn; 71.3 (N\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e239 \u0026plusmn; 77.6 (N\u0026thinsp;=\u0026thinsp;386)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e197.8 \u0026plusmn; 74.2 (N\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eINR at ER (mean \u0026plusmn; SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1 \u0026plusmn; 0.3 (N\u0026thinsp;=\u0026thinsp;1,564)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3 \u0026plusmn; 0.7 (N\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1 \u0026plusmn; 0.3 (N\u0026thinsp;=\u0026thinsp;384)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.4 \u0026plusmn; 0.7 (N\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eICU stay\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 1,225 (74.6%), yes: 418 (25.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 23 (56.1%), yes: 18 (43.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 109 (28.1%), yes: 279 (71.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 25 (31.3%), yes: 55 (68.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMechanical ventilation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 1,411 (91.1%), yes: 138 (8.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 26 (63.4%), yes: 15 (36.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 161 (42.5%), yes: 218 (57.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 26 (32.5%), yes: 54 (67.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eISS\u0026thinsp;\u0026ge;\u0026thinsp;16 (N, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 1,331 (81.0%), yes: 312 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 19 (46.3%), yes: 22 (53.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 200 (51.6%), yes: 188 (48.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 9 (11.3%), yes: 71 (88.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;2 injured regions\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e(N, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno: 576 (35.1%), yes: 1,067 (64.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eno: 15 (36.6%), yes: 26 (63.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eno: 106 (27.3%), yes: 282 (72.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eno: 32 (40.0%), yes: 48 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAbbreviations: NACA: National Advisory Committee for Aeronautics score, GCS: Glasgow Coma Scale, ER: Emergency Room, INR: International Normalized Ratio, ICU: intensive care unit, ISS: injury Severity Score, N: number of patients, SD: standard deviation, m: meters, mL: milliliters, g/dL: grams/deciliter, L: liter\u003c/em\u003e, \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eOther includes: shooting, stabbing, hitting, explosion, avalanche and unknown\u003c/em\u003e, \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ePossible injured regions: head, face, neck, cervical spine, thoracic spine, lumbar spine, thorax, abdomen, upper extremity, lower extremity and pelvis, external (skin) and thermal injuries.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatients\u0026rsquo; characteristics: survivors vs non-survivors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of the comparative analysis between survivors and non-survivors, including all patients as well as the NACA 4 and NACA 5 subgroups evaluated separately, are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were found in all prehospital and hospital variables, as well as within \u0026ldquo;age\u0026rdquo;. In both NACA 4 and NACA 5 subgroups, most parameters were statistically significant. Key variables included age, GCS (prehospital and hospital), prehospital intubation, hemoglobin, thrombocyte count, and INR (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In the NACA 4 subgroup, prehospital resuscitation (p\u0026thinsp;=\u0026thinsp;0.024), ICU admission (p\u0026thinsp;=\u0026thinsp;0.008), and mechanical ventilation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) differed significantly between survivors and non-survivors. In the NACA 5 subgroup, prehospital use of vasoactive drugs (p\u0026thinsp;=\u0026thinsp;0.001) and fluids (p\u0026thinsp;=\u0026thinsp;0.040), as well as injuries in \u0026ge;\u0026thinsp;2 regions (p\u0026thinsp;=\u0026thinsp;0.024) differed significantly between survivors and non-survivors. A significant difference was identified for the injury severity defined by an ISS\u0026thinsp;\u0026ge;\u0026thinsp;16 between survivors and non-survivors both in the main analysis and in the two sub-analyses (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eUnivariate analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor the entire patient cohort, age and all analyzed prehospital, and hospital collected variables were identified as significant risk factors influencing mortality (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHigher age, higher NACA score, prehospital resuscitation, intubation, administration of fluids or vasoactive drugs, need for ICU admission, mechanical ventilation, elevated INR levels were all associated with higher mortality risk (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Lower prehospital and hospital GCS, as well as reduced hemoglobin and thrombocyte levels, were also significant predictors for increased mortality risk. Additionally, the severity of sustained injuries, as indicated by an ISS\u0026thinsp;\u0026ge;\u0026thinsp;16 was also identified as a significant predictor of mortality.\u003c/p\u003e\u003cp\u003eSubgroup analysis confirmed significant associations with most variables for both NACA 4 and NACA 5 subgroups, particularly age, prehospital and hospital GCS, prehospital intubation, laboratory values \u0026ndash; including hemoglobin and thrombocytes \u0026ndash; and ISS\u0026thinsp;\u0026ge;\u0026thinsp;16. Some variables showed subgroup-specific effects: in the NACA 4 group, the need for ICU admission (\u003cem\u003eOR\u003c/em\u003e 2.29, p\u0026thinsp;=\u0026thinsp;0.009) and use of mechanical ventilation (\u003cem\u003eOR\u003c/em\u003e 5.90, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) were significantly associated with mortality risk. In the NACA 5 subgroup, prehospital administration of vasoactive drugs (\u003cem\u003eOR\u003c/em\u003e 2.70, p\u0026thinsp;=\u0026thinsp;0.001), fluids (\u003cem\u003eOR\u003c/em\u003e 0.19, p\u0026thinsp;=\u0026thinsp;0.024), and sustaining injuries in \u0026ge;\u0026thinsp;2 anatomical regions (\u003cem\u003eOR\u003c/em\u003e 0.56, p\u0026thinsp;=\u0026thinsp;0.025), were significant predictors of mortality.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate logistic regression for predictors of mortality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e All patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e NACA 4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e NACA 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.07 (1.05\u0026ndash;1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.14 (1.10\u0026ndash;1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.06 (1.05\u0026ndash;1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.26 (5.58\u0026ndash;12.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGCS prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.76 (0.73\u0026ndash;0.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78 (0.71\u0026ndash;0.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.83 (0.78\u0026ndash;0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReanimation prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.91 (2.13\u0026ndash;22.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.19 (0.93\u0026ndash;71.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.98 (0.70-12.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.140\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntubation prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.34 (7.67\u0026ndash;16.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.21 (1.16\u0026ndash;23.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.031*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.37 (2.57\u0026ndash;7.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVasoactive drugs prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.41 (4.30-12.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.12 (0.40-24.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.70 (1.47\u0026ndash;4.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFluids prehospital\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.39 (1.87\u0026ndash;10.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.48 (0.145\u0026ndash;1.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.19 (0.04\u0026ndash;0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.024*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGCS at ER\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77 (0.74\u0026ndash;0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.74 (0.69\u0026ndash;0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.82 (0.77\u0026ndash;0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemoglobin at ER\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.70 (0.64\u0026ndash;0.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68 (0.60\u0026ndash;0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81 (0.73\u0026ndash;0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThrombocytes at ER\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.99 (0.987\u0026ndash;0.993)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99 (0.987-1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.003*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.99 (0.987\u0026ndash;0.995)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eINR at ER\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.90 (2.13\u0026ndash;3.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.40 (1.55\u0026ndash;3.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.45 (2.27\u0026ndash;8.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eICU stay\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.91 (2.0-4.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.29 (1.23\u0026ndash;4.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.009*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86 (0.51\u0026ndash;1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.570\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMechanical ventilation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.86 (4.02\u0026ndash;8.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.90 (3.05\u0026ndash;11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.53 (0.92\u0026ndash;2.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eISS\u0026thinsp;\u0026ge;\u0026thinsp;16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.17 (6.59\u0026ndash;15.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.94 (2.64\u0026ndash;9.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.39 (4.08\u0026ndash;17.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;2 injured regions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.80 (0.55\u0026ndash;1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.94 (0.49\u0026ndash;1.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.840\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.56 (0.34\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.025*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAbbreviations: NACA: National Advisory Committee for Aeronautics score, GCS: Glasgow Coma Scale, ER: Emergency Room, INR: International Normalized Ratio, ICU: intensive care unit, ISS: injury Severity Score, OR: odds ratio\u003c/em\u003e, \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eOR and 95%-CI in brackets, OR\u0026thinsp;\u0026gt;\u0026thinsp;1: death more likely if variable is higher or present, OR\u0026thinsp;\u0026lt;\u0026thinsp;1: death more likely if variable is lower or absent\u003c/em\u003e, \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e \u003cem\u003esignificance level *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e, \u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e \u003cem\u003edifferent groups were analysed against each other, most significant association is indicated.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe multivariate analysis of the prehospital variables (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) showed that age (\u003cem\u003eOR\u003c/em\u003e 1.11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), NACA score (\u003cem\u003eOR\u003c/em\u003e 2.96, p\u0026thinsp;=\u0026thinsp;0.002), GCS (\u003cem\u003eOR\u003c/em\u003e 0.78, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), reanimation (\u003cem\u003eOR\u003c/em\u003e 7.22, p\u0026thinsp;=\u0026thinsp;0.039), and administration of vasoactive drugs (\u003cem\u003eOR\u003c/em\u003e 2.38, p\u0026thinsp;=\u0026thinsp;0.037) were statistically significant independent risk factors for all included patients, while intubation and administration of liquids were not.\u003c/p\u003e\u003cp\u003eIn the NACA 4 subgroup analysis only age (\u003cem\u003eOR\u003c/em\u003e 1.13, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and GCS (\u003cem\u003eOR\u003c/em\u003e 0.69, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) emerged as statistically significant predictors of mortality.\u003c/p\u003e\u003cp\u003eIn the NACA 5 patients age (\u003cem\u003eOR\u003c/em\u003e 1.09, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), GCS (\u003cem\u003eOR\u003c/em\u003e 0.82, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and administration of vasoactive drugs (\u003cem\u003eOR\u003c/em\u003e 2.4, p\u0026thinsp;=\u0026thinsp;0.039) emerged as statistically significant predictors of mortality.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate logistic regression for predictors of mortality with prehospital variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e All patients (N\u0026thinsp;=\u0026thinsp;1,818)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e NACA 4\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1,427)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e NACA 5\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;391)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep value\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.11 (1.08\u0026ndash;1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.13 (1.09\u0026ndash;1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.09 (1.06\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNACA score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.96 (1.48\u0026ndash;5.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGCS prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.78 (0.72\u0026ndash;0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69 (0.58\u0026ndash;0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.82 (0.75\u0026ndash;0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReanimation prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.22 (1.11-47.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.039*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.02 (0.90-218.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.02 (0.38\u0026ndash;94.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.202\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntubation prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.56 (0.68\u0026ndash;3.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.58 (0.03\u0026ndash;10.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.81 (0.78\u0026ndash;4.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVasoactive drugs prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.38 (1.05\u0026ndash;5.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.037*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.47 (0.01\u0026ndash;19.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.696\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.40 (1.05\u0026ndash;5.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.039*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFluids prehospital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84 (0.55\u0026ndash;1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70 (0.22-2-27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87 (0.56\u0026ndash;1.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.550\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAbbreviations: NACA: National Advisory Committee for Aeronautics score, GCS: Glasgow Coma Scale, OR: odds ratio\u003c/em\u003e, \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eOR and 95%-CI in brackets, OR\u0026thinsp;\u0026gt;\u0026thinsp;1: death more likely if variable is higher or present, OR\u0026thinsp;\u0026lt;\u0026thinsp;1: death more likely if variable is lower or absent\u003c/em\u003e, \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e \u003cem\u003esignificance level *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe main finding of this study is that different factors can influence the mortality risk beyond the mere NACA 4 and 5 classification of polytrauma patients, including reanimation, administration of vasoactive drugs, GCS, and age.\u003c/p\u003e\u003cp\u003ePrevious studies investigated the NACA score showing good correlations between the NACA score and survival as well as a strong ability to predict mortality for trauma patients.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] This study builds upon these findings, confirming such results for NACA 4 and NACA 5 patients. The univariate logistic regression analysis revealed a significant difference in NACA score between survivors and non-survivors. By including all prehospital variables, this study demonstrated that the distinction between NACA 4 and NACA 5 was associated with an almost 300% increase in mortality risk. Hence, it can be regarded as a valid score for the early prehospital assessment of mortality in trauma patients.\u003c/p\u003e\u003cp\u003eThis study found significant differences between survivors and non-survivors in both prehospital and hospital factors. In addition to the NACA score, key mortality predictors included age, prehospital and hospital GCS, need for advanced interventions (e.g., resuscitation, intubation, vasoactive drugs, fluids), ICU admission, mechanical ventilation, specific laboratory values, and ISS\u0026thinsp;\u0026ge;\u0026thinsp;16. In the multivariate analysis, age, GCS, and NACA score emerged as the strongest independent predictors of mortality, highlighting their value in guiding early management before hospital admission.\u003c/p\u003e\u003cp\u003eOlder age and low GCS have been previously identified as independent mortality predictors in trauma patients and were therefore added to various definitions and scores related to trauma to increase their predictive power on survival.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] This study confirmed both factors as significant predictors in univariate and multivariate analyses in all patient groups. Several other risk factors have been evaluated for their impact on mortality in polytrauma patients. Among these, traumatic cardiac arrest is recognized as both rare and highly fatal. Seewald et al. reported 4% of cardiac arrests stemmed from major trauma, with a 95% mortality rate.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] The present study specifically analyzed prehospital reanimation in trauma patients as a risk factor for mortality and found significant results when including all NACA 4 and NACA 5 patients in the multivariate analysis, indicating that the necessity of prehospital reanimation has the biggest impact on mortality.\u003c/p\u003e\u003cp\u003ePrehospital intubation was another significant mortality risk factor identified by the univariate analysis, both in the main analysis and in the NACA 4 and NACA 5 sub-analyses. However, this association did not retain statistical significance in the multivariate analysis. Previous investigations reported mixed findings regarding the impact of prehospital intubation and focused primarily on the comparison between prehospital and hospital intubation without examining prehospital intubation as an independent risk factor for mortality.[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Additionally, they focused on patients with isolated traumatic brain injury (TBI) rather than on the general polytraumatized population. The findings of the present study build upon these previous results suggesting that prehospital intubation could play a role, albeit not being the most relevant factor influencing mortality in polytrauma patients.\u003c/p\u003e\u003cp\u003eFluids or vasoactive drugs are often used for prehospital hemodynamic support in polytrauma patients. The univariate analysis showed that an increased administration of fluids was associated with an increased mortality in all patients combined. However, counterintuitively a decreased risk of death was found for the separate analysis of the NACA 5 subgroup. This apparent contradiction may reflect the heterogeneity between NACA 4 and 5 patients, with fluid use potentially indicating greater injury severity in the former, and timely intervention in the latter.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] The administration of a greater amount of fluids may be a sign of earlier recognition of hemodynamic instability and earlier treatment leading to increased survival. The administration of vasoactive drugs was significantly associated with increased mortality both overall and within the NACA 5 subgroup, aligning with previous studies.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Multivariate analysis showed that fluid administration was not an independent predictor of mortality, while vasoactive drug use significantly increased mortality in both the overall cohort and the NACA 5 subgroup. These findings support the NACA score\u0026rsquo;s ability to distinguish between patients at immediate (NACA 5) and potential (NACA 4) risk of life-threatening conditions.\u003c/p\u003e\u003cp\u003eConcerning the parameters collected in the ED, parameters such as low GCS, hemoglobin, thrombocyte levels, and coagulopathy were confirmed as significant mortality risk predictors, in line with previous studies.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] Conversely, the impact of ICU admission and mechanical ventilation with its influence on mortality in polytrauma patients is less well studied, as most prior research focused solely on ICU-admitted populations.[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] This current study showed a significant association with mortality in the overall cohort and the NACA 4 subgroup, while the NACA 5 subgroup did not indicate an association between ICU admission and mechanical ventilation with patients\u0026rsquo; survival. This may reflect a possible confounding factor, as more severely injured NACA 5 patients may have died before ICU admission or before mechanical ventilation could be initiated and registry documented.\u003c/p\u003e\u003cp\u003eThe assessment of injury severity measured by an ISS\u0026thinsp;\u0026ge;\u0026thinsp;16 is another widely acknowledged as a strong predictor of mortality. Current findings reinforce this association in both NACA 4 and NACA 5 subgroups. However, the injury distribution analysis showed that involvement of multiple regions was significantly associated with survival only in NACA 5. The Univariate analysis demonstrated a lower mortality risk in patients with multiple injured regions, suggesting that certain isolated injuries, such as severe traumatic brain injury or major thoracic trauma, may carry a disproportionately higher mortality risk than multi-region injuries of moderate severity. Similarly, Paffrath et al. reported lower mortality (18.7%) in patients with multiple injuries versus 20.4% overall and 31% in monotrauma cases (AIS 4 or 5), highlighting the need to integrate physiological criteria into major trauma definitions to improve mortality risk stratification. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThis study presents several limitations that must be noted. Its registry-based design may have introduced biases due to missing or inconsistent data, particularly regarding vital signs like arterial blood pressure and laboratory results. The absence of information on comorbidities and systemic inflammatory response (SIRS) criteria further limits the analysis. While the multivariate analysis helped providing a control of confounding bias, residual confounding bias could not be excluded. Despite these limitations, the study offers valuable insights into mortality risk factors in polytrauma patients. A major strength lies in the large and diverse cohort, enabling a broad evaluation of predictors across different trauma severities and care settings. The inclusion of extensive prehospital and hospital variables, along with both univariate and multivariate analyses, enhances the reliability and depth of the findings. Analyzing NACA 4 and NACA 5 subgroups separately revealed meaningful differences in mortality predictors, highlighting the importance of tailored clinical approaches. The findings suggest that factors such as reanimation, vasoactive drug use, GCS, and age significantly impact mortality, beyond the NACA classification alone. Recognizing these parameters early may support more targeted interventions.\u003c/p\u003e\u003cp\u003eOverall, this study contributes to the ongoing optimization of polytrauma care. Improvements in prehospital response, early injury recognition, and trauma system organization are key to enhancing the outcome and the survival rate of these patients. Future prospective studies with standardized clinical data and long-term outcomes are needed to better understand how injury severity, interventions, and individual patient factors interact in shaping prognosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Abbreviated. Injury Scale\u003c/p\u003e\n\u003cp\u003eED\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Emergency department\u003c/p\u003e\n\u003cp\u003eER\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Emergency room\u003c/p\u003e\n\u003cp\u003eGCS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Glasgow Coma Scale\u003c/p\u003e\n\u003cp\u003eICU\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Intensive care unit\u003c/p\u003e\n\u003cp\u003eINR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;International Normalized Ratio\u003c/p\u003e\n\u003cp\u003eISS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Injury Severity Score\u003c/p\u003e\n\u003cp\u003eN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Number of patients\u003c/p\u003e\n\u003cp\u003eNACA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;National Advisory Committee for Aeronautics\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Odds ratio\u003c/p\u003e\n\u003cp\u003eSD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard deviation\u003c/p\u003e\n\u003cp\u003eSIRS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Systemic inflammatory response\u003c/p\u003e\n\u003cp\u003eSTR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Swiss Trauma Registry\u003c/p\u003e\n\u003cp\u003eTBI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Traumatic Brain Injury\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the local cantonal ethics committee of the Canton of Tessin, Switzerland (prot 2024-00236 CE 4536).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was extracted from the Local Polytrauma Registry affiliated to the Swiss Trauma Registry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo Funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIS, MR and GF designed the study. IS, MR, AB and GF analysed the data. IS drafted the manuscript. MR, AB, ASM, PIF and GF reviewed the manuscript.\u0026nbsp;All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Prof. Dr. med. Alberto Pagnamenta for his work in the statistical analysis.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eInjuries and violence: the facts 2014\u003c/em\u003e. World Health Organization 2014. https://iris.who.int/handle/10665/149798 (accessed 4 Feb2025).\u003c/li\u003e\n\u003cli\u003eBouillon B, Neugebauer E. Outcome after polytrauma. \u003cem\u003eLangenbecks Arch Surg\u003c/em\u003e 1998;\u003cstrong\u003e383\u003c/strong\u003e:228\u0026ndash;34.\u003c/li\u003e\n\u003cli\u003eLotfalla A, Halm J, Schepers T, Giannak\u0026oacute;poulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). \u003cem\u003eEur J Trauma Emerg Surg\u003c/em\u003e 2023;\u003cstrong\u003e49\u003c/strong\u003e:747\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eButcher N, Balogh ZJ. The definition of polytrauma: the need for international consensus. \u003cem\u003eInjury\u003c/em\u003e 2009;\u003cstrong\u003e40 Suppl 4\u003c/strong\u003e:S12-22.\u003c/li\u003e\n\u003cli\u003eButcher NE, D\u0026rsquo;Este C, Balogh ZJ. The quest for a universal definition of polytrauma: A trauma registry-based validation study. \u003cem\u003eJournal of Trauma and Acute Care Surgery\u003c/em\u003e 2014;\u003cstrong\u003e77\u003c/strong\u003e:620.\u003c/li\u003e\n\u003cli\u003ePape H-C, Lefering R, Butcher N, Peitzman A, Leenen L, Marzi I, \u003cem\u003eet al.\u003c/em\u003e The definition of polytrauma revisited: An international consensus process and proposal of the new \u0026lsquo;Berlin definition\u0026rsquo;. \u003cem\u003eJ Trauma Acute Care Surg\u003c/em\u003e 2014;\u003cstrong\u003e77\u003c/strong\u003e:780\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003ePaffrath T, Lefering R, Floh\u0026eacute; S. How to define severely injured patients?\u0026mdash;An Injury Severity Score (ISS) based approach alone is not sufficient. \u003cem\u003eInjury\u003c/em\u003e 2014;\u003cstrong\u003e45\u003c/strong\u003e:S64\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eFrenzel S, Krenn P, Heinz T, Negrin LL. Does the applied polytrauma definition notably influence outcome and patient population? \u0026ndash; a retrospective analysis. \u003cem\u003eScandinavian Journal of Trauma, Resuscitation and Emergency Medicine\u003c/em\u003e 2017;\u003cstrong\u003e25\u003c/strong\u003e:87.\u003c/li\u003e\n\u003cli\u003eTryba. Klassifizierung von Erkrankungen und Verletzungen im Notarztrettungssystem. Notfallmedizin 1980; 8:725\u0026ndash;727. \u003c/li\u003e\n\u003cli\u003eWeiss M, Bernoulli L, Zollinger A. Der NACA-IndexAussagekraft und Stellenwert des modifizierten NACA-Indexes in der pr\u0026auml;klinischen Schweregraderfassung von Unfallpatienten. \u003cem\u003eAnaesthesist\u003c/em\u003e 2001;\u003cstrong\u003e50\u003c/strong\u003e:150\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eDarioli V, Taff\u0026eacute; P, Carron P-N, Dami F, Vallotton L, Yersin B, \u003cem\u003eet al.\u003c/em\u003e Evaluation of the discriminative performance of the prehospital National Advisory Committee for Aeronautics score regarding 48-h mortality. \u003cem\u003eEuropean Journal of Emergency Medicine\u003c/em\u003e 2019;\u003cstrong\u003e26\u003c/strong\u003e:366.\u003c/li\u003e\n\u003cli\u003eFiore PI, Monteleone AS, M\u0026uuml;ller J, Filardo G, Candrian C, Riegger M. The NACA score predicts mortality in polytrauma patients before hospital admission: a registry-based study. \u003cem\u003eScand J Trauma Resusc Emerg Med\u003c/em\u003e 2024;\u003cstrong\u003e32\u003c/strong\u003e:116.\u003c/li\u003e\n\u003cli\u003eSwiss Trauma Board. Swiss Trauma Registry (STR). https://www.swisstraumaboard.ch/ (accessed 11 Jun2024).\u003c/li\u003e\n\u003cli\u003eTeasdale G, Jennett B. ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale. \u003cem\u003eThe Lancet\u003c/em\u003e 1974;\u003cstrong\u003e304\u003c/strong\u003e:81\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eBaker SP, O\u0026rsquo;Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. \u003cem\u003eJ Trauma\u003c/em\u003e 1974;\u003cstrong\u003e14\u003c/strong\u003e:187\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eRau C-S, Wu S-C, Kuo P-J, Chen Y-C, Chien P-C, Hsieh H-Y, \u003cem\u003eet al.\u003c/em\u003e Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e 2017;\u003cstrong\u003e14\u003c/strong\u003e:1045.\u003c/li\u003e\n\u003cli\u003eKondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. \u003cem\u003eCritical Care\u003c/em\u003e 2011;\u003cstrong\u003e15\u003c/strong\u003e:R191.\u003c/li\u003e\n\u003cli\u003eda Costa LGV, Carmona MJC, Malbouisson LM, Rizoli S, Rocha-Filho JA, Cardoso RG, \u003cem\u003eet al.\u003c/em\u003e Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study. \u003cem\u003eClinics (Sao Paulo)\u003c/em\u003e 2017;\u003cstrong\u003e72\u003c/strong\u003e:461\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eSeewald S, Wnent J, Gr\u0026auml;sner J-T, Tjelmeland I, Fischer M, Bohn A, \u003cem\u003eet al.\u003c/em\u003e Survival after traumatic cardiac arrest is possible\u0026mdash;a comparison of German patient-registries. \u003cem\u003eBMC Emergency Medicine\u003c/em\u003e 2022;\u003cstrong\u003e22\u003c/strong\u003e:158.\u003c/li\u003e\n\u003cli\u003eDenninghoff KR, Nu\u0026ntilde;o T, Pauls Q, Yeatts SD, Silbergleit R, Palesch YY, \u003cem\u003eet al.\u003c/em\u003e Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT III. \u003cem\u003ePrehospital Emergency Care\u003c/em\u003e 2017;\u003cstrong\u003e21\u003c/strong\u003e:539\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eFevang E, Perkins Z, Lockey D, Jeppesen E, Lossius HM. A systematic review and meta-analysis comparing mortality in pre-hospital tracheal intubation to emergency department intubation in trauma patients. \u003cem\u003eCritical Care\u003c/em\u003e 2017;\u003cstrong\u003e21\u003c/strong\u003e:192.\u003c/li\u003e\n\u003cli\u003eRenberg M, Dahlberg M, Gellerfors M, Rostami E, G\u0026uuml;nther M. Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade. \u003cem\u003eScandinavian Journal of Trauma, Resuscitation and Emergency Medicine\u003c/em\u003e 2023;\u003cstrong\u003e31\u003c/strong\u003e:85.\u003c/li\u003e\n\u003cli\u003eSperry JL, Minei JP, Frankel HL, West MA, Harbrecht BG, Moore EE, \u003cem\u003eet al.\u003c/em\u003e Early use of vasopressors after injury: caution before constriction. \u003cem\u003eJ Trauma\u003c/em\u003e 2008;\u003cstrong\u003e64\u003c/strong\u003e:9\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eHylands M, Toma A, Beaudoin N, Frenette AJ, D\u0026rsquo;Aragon F, Belley-C\u0026ocirc;t\u0026eacute; \u0026Eacute;, \u003cem\u003eet al.\u003c/em\u003e Early vasopressor use following traumatic injury: a systematic review. \u003cem\u003eBMJ Open\u003c/em\u003e 2017;\u003cstrong\u003e7\u003c/strong\u003e:e017559.\u003c/li\u003e\n\u003cli\u003ede Vries R, Reininga IHF, de Graaf MW, Heineman E, El Moumni M, Wendt KW. Older polytrauma: Mortality and complications. \u003cem\u003eInjury\u003c/em\u003e 2019;\u003cstrong\u003e50\u003c/strong\u003e:1440\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eMica L, Rufibach K, Keel M, Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. \u003cem\u003eJ Trauma Manag Outcomes\u003c/em\u003e 2013;\u003cstrong\u003e7\u003c/strong\u003e:6.\u003c/li\u003e\n\u003cli\u003eJin WYY, Jeong JH, Kim DH, Kim TY, Kang C, Lee SH, \u003cem\u003eet al.\u003c/em\u003e Factors predicting the early mortality of trauma patients. \u003cem\u003eUlus Travma Acil Cerrahi Derg\u003c/em\u003e 2018;\u003cstrong\u003e24\u003c/strong\u003e:532\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eB\u0026ouml;hmer AB, Just KS, Lefering R, Paffrath T, Bouillon B, Joppich R, \u003cem\u003eet al.\u003c/em\u003e Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases. \u003cem\u003eCritical Care\u003c/em\u003e 2014;\u003cstrong\u003e18\u003c/strong\u003e:R143.\u003c/li\u003e\n\u003cli\u003ePrin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. \u003cem\u003eInjury Epidemiology\u003c/em\u003e 2016;\u003cstrong\u003e3\u003c/strong\u003e:18.\u003c/li\u003e\n\u003cli\u003ePapadimitriou-Olivgeris M, Panteli E, Koutsileou K, Boulovana M, Zotou A, Marangos M, \u003cem\u003eet al.\u003c/em\u003e Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study☆. \u003cem\u003eBrazilian Journal of Anesthesiology (English Edition)\u003c/em\u003e 2021;\u003cstrong\u003e71\u003c/strong\u003e:23\u0026ndash;30.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"stre","sideBox":"Learn more about [Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine](http://sjtrem.biomedcentral.com)","snPcode":"13049","submissionUrl":"https://submission.nature.com/new-submission/13049/3","title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","twitterHandle":"@SJTREM","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"polytrauma, registry, NACA score, emergency medicine, GCS, ISS","lastPublishedDoi":"10.21203/rs.3.rs-7107823/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7107823/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 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), reanimation (OR 7.22), and administration of vasoactive drugs (OR 2.38) were statistically significant independent risk factors for all included patients (p \u0026lt; 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 \u0026lt; 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 \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study demonstrated that different factors can influence the mortality risk of polytrauma patients beyond the mere NACA 4 and 5 classification, including reanimation, 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence (LoE): \u003c/strong\u003eIII\u003c/p\u003e","manuscriptTitle":"Effect of different factors on predicting patient mortality beyond the NACA classification: a multivariate analysis of more than 2,000 polytrauma patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 06:20:41","doi":"10.21203/rs.3.rs-7107823/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-22T09:26:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T12:23:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T11:41:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164604858520298898847440772041894672994","date":"2025-08-12T11:37:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248722444240297408167495371524306052656","date":"2025-08-10T13:09:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-10T10:53:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-14T10:08:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-14T10:05:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","date":"2025-07-12T11:19:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"stre","sideBox":"Learn more about [Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine](http://sjtrem.biomedcentral.com)","snPcode":"13049","submissionUrl":"https://submission.nature.com/new-submission/13049/3","title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","twitterHandle":"@SJTREM","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c2e90154-df1b-44e4-833c-651925eb2a85","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:01:35+00:00","versionOfRecord":{"articleIdentity":"rs-7107823","link":"https://doi.org/10.1186/s13049-025-01511-2","journal":{"identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isVorOnly":false,"title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine"},"publishedOn":"2025-12-29 15:57:21","publishedOnDateReadable":"December 29th, 2025"},"versionCreatedAt":"2025-08-18 06:20:41","video":"","vorDoi":"10.1186/s13049-025-01511-2","vorDoiUrl":"https://doi.org/10.1186/s13049-025-01511-2","workflowStages":[]},"version":"v1","identity":"rs-7107823","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7107823","identity":"rs-7107823","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}