Development and Internal Validation of a Multimodal Prediction Score for Early Hemodynamic Deterioration in Adult Polytrauma Patients

Development and Internal Validation of a Multimodal Prediction Score for Early Hemodynamic Deterioration in Adult Polytrauma Patients: A Prospective Cohort Study

Severe traumatic injury involving multiple body regions (polytrauma) carries a high risk of rapid bleeding, tissue hypoperfusion, and circulatory collapse. In the emergency setting, standard vital signs such as blood pressure and heart rate alone may not detect impending circulatory failure until significant deterioration has already occurred.

The purpose of this prospective observational cohort study is to develop and internally validate a bedside clinical prediction model that identifies adult polytrauma patients at risk of early hemodynamic deterioration within 24 hours of arrival at the Emergency Department of Assiut University Hospital.

Eligible adult patients presenting with acute trauma across at least two major body regions within 6 hours of injury will receive standard clinical evaluation and trauma resuscitation. Alongside routine care, researchers will record baseline predictor variables during initial evaluation, including:

• Shock Index, calculated from heart rate and systolic blood pressure.
• Inferior vena cava (IVC) respiratory collapsibility assessed via non-invasive bedside point-of-care ultrasound.
• Initial blood gas and biochemical markers, including blood lactate concentration and base deficit.
• Baseline neurological status using the Glasgow Coma Scale (GCS) and patient age.

Participants will be followed for 24 hours to monitor for hemodynamic deterioration, defined as persistent or recurrent hypotension, the need for vasopressor or inotropic medications, major blood transfusion (at least 4 units of packed red blood cells), emergency surgical or interventional procedures to control bleeding, or trauma-related circulatory collapse death. The gathered data will be analyzed according to TRIPOD guidelines to create a multimodal risk tool that can assist emergency clinicians in recognizing high-risk trauma patients early.

Study Overview

• Status: Not yet recruiting
• Conditions: Hemorrhage; Multiple Trauma; Hemodynamic Instability; Polytrauma; Traumatic Shock

• Study Type: Observational
• Enrollment (Estimated): 300

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Consecutive adult polytrauma patients aged 18 years or older presenting to the Emergency Department of Assiut University Hospital within 6 hours of sustaining acute traumatic injuries involving at least two distinct predefined major anatomical body regions requiring hospital-level trauma evaluation or management.

Description

Inclusion Criteria:

• Age 18 years or older.
• Acute traumatic injury involving at least two distinct predefined major anatomical body regions.
• Presentation to the Emergency Department within 6 hours of injury.
• Injuries requiring hospital-level trauma evaluation or management (operational definition of polytrauma).
• Ability to obtain baseline predictor assessments (heart rate and systolic blood pressure for Shock Index, initial serum lactate, initial base deficit, and attempted point-of-care inferior vena cava ultrasound) as early as clinically feasible after ED arrival.
• Informed consent obtained according to institutional and ethical requirements (from the patient or legally authorized representative).
• Note: Hemodynamic stability at ED arrival is not required; patients presenting with hypotension (SBP <90 mmHg), elevated Shock Index, or clinical shock remain eligible provided baseline predictor measurements can be obtained.

Exclusion Criteria:

• Isolated trauma involving only one anatomical body region.
• Age younger than 18 years.
• Pregnancy.
• Invasive mechanical ventilation initiated prior to baseline inferior vena cava (IVC) assessment.
• Known severe pre-existing cardiac dysfunction likely to substantially alter IVC respiratory dynamics (e.g., severe right heart failure, significant tricuspid regurgitation).
• Significant chronic hepatic dysfunction likely to substantially interfere with baseline serum lactate clearance and interpretation.
• Traumatic obstructive shock identified before baseline assessment (e.g., tension pneumothorax, cardiac tamponade) and resolved prior to obtaining measurements.
• Transfer from an outside facility following substantial resuscitation (prior blood-product administration, vasopressor therapy, emergent surgery, or interventional radiology).
• Inability to obtain baseline predictor measurements within the initial assessment window due to immediate priority of life-saving resuscitative procedures.
• Missing baseline clinical or laboratory parameters preventing calculation of the primary prediction model.
• Note: Inability to obtain an adequate IVC acoustic window alone is recorded as an ultrasound feasibility failure and does not exclude the patient.

Study Plan

How is the study designed?

Design Details

• Observational Models: COHORT
• Time Perspectives: PROSPECTIVE

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Adult Polytrauma Cohort; Consecutive adult polytrauma patients aged 18 years or older presenting to the Emergency Department within 6 hours of acute injury involving at least two distinct major anatomical regions. Participants receive standard trauma evaluation and resuscitation alongside baseline observational predictor assessments, including Shock Index (heart rate/systolic blood pressure), point-of-care ultrasound measurement of inferior vena cava (IVC) respiratory collapsibility, initial serum lactate, initial base deficit from blood gas analysis, age, and Glasgow Coma Scale (GCS). Participants are followed for 24 hours to evaluate for early hemodynamic deterioration.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Early Hemodynamic Deterioration	Number of participants experiencing early hemodynamic deterioration, defined as a single composite binary endpoint if a participant meets at least one of the following criteria: systolic blood pressure < 90 mmHg persisting for at least 15 minutes despite initial resuscitation, initiation of vasopressor or inotropic support, transfusion of at least 4 units of packed red blood cells, emergency definitive surgical or interventional radiological hemorrhage-control procedure, or trauma-related circulatory collapse death.	Up to 24 hours

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): October 1, 2027
• Study Completion (Estimated): November 1, 2027

Study Registration Dates

• First Submitted: September 24, 2026
• First Submitted That Met QC Criteria: September 24, 2026
• First Posted (Actual): September 30, 2026

Study Record Updates

• Last Update Posted (Actual): September 30, 2026
• Last Update Submitted That Met QC Criteria: September 24, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Keywords: Emergency Department; Point-of-Care Ultrasound; Serum Lactate; Shock Index; Clinical Prediction Model; Base Deficit; Inferior Vena Cava Collapsibility; TRIPOD
• Additional Relevant MeSH Terms: Wounds and Injuries; Pathologic Processes; Disease Attributes; Shock; Pathological Conditions, Signs and Symptoms; Multiple Trauma; Emergencies; Hemorrhage; Shock, Traumatic
• Other Study ID Numbers: Polytrauma Deterioration Score