Validation of Prehospital Predictor of Macroaspiration at Trauma Site Score: Correlating with Mortality following Severe Aspiration Pneumonia

Abstract

Introduction Predictor of macroaspiration at trauma site (PMAT) scoring was introduced to assess the role of early interventions including check bronchoscopy in improving the outcome of patients with severe brain injury. This article presents the statistical evaluation of the scoring method and suggests modifications of the same for further applications.

Materials and Methods Data of 67 patients treated by the authors were evaluated with statistical tools with the objective of predicting macroaspiration and mortality due to pneumonia following severe traumatic brain injury. Fisher exact test was employed to study relationship between PMAT scores and finding of macroaspirate on bronchoscopy.

Results Mean PMAT scores among those who died due to pneumonia versus those who did not die were compared. Mean PMAT scores were higher among those who died due to pneumonia (10.43 vs. 9.60) but not significantly higher (p = 0.181). When PMAT score was categorized into low or high (low for scores less than 9 and high for scores 9 and above) and a chi-square test was applied, the results were significant, that is, those with high PMAT score have higher risk of death due to pneumonia. With the present data, the score failed the internal validation test to predict a macroaspiration event alone.

Conclusion The PMAT appears to be valid with regard to its predictability of high risk of death due to pneumonia or in other words, the severity of aspiration pneumonia. The study suggests a pilot guideline for future similar studies to categorize the study groups according to the score and assess possible adverse outcome. The shortcomings of the study include single investigator, single-center study, small sample size, and absence of a valid guideline to begin with. Future studies will need to address these issues.

Keywords

aspiration pneumonia - brain injury - PMAT score - rural India

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