NACA score

Abstract: Introduction The National Advisory Committee on Aeronautics' (NACA) severity score is widely used in pre-hospital emergency medicine to grade the severity of illness or trauma in patient groups but is scarcely validated. The aim of this study was to assess the score's ability to predict mortality and need for advanced in-hospital interventions in a cohort from one anaesthesiologist-manned helicopter service in Northern Norway. Methods All missions completed by one helicopter service during January 1999 to December 2009 were reviewed. One thousand eight hundred forty-one patients were assessed by the NACA score. Pre-hospital and in-hospital interventions were collected from patient records. The relationship between NACA score and the outcome measures was assessed using receiver operating characteristic (ROC) curves. Results A total of 1533 patients were included in the analysis; uninjured and dead victims were excluded per protocol. Overall mortality rate of the patients with NACA score 1–6 was 5.2%. Trauma patients with NACA score 1–6 had overall mortality rate of 1.9% (12/625) and non-trauma patients 7.4% (67/908). The NACA score's ability to predict mortality was assessed by using ROC area under curve (AUC) and was 0.86 for all, 0.82 for non-trauma and 0.98 for trauma patients. The NACA score's ability to predict a need for respiratory therapy within 24 h revealed an AUC of 0.90 for all patients combined. Conclusion The NACA score had good discrimination for predicting mortality and need for respiratory therapy. It is thus useful as a tool to measure overall severity of the patient population in this kind of emergency medicine system.

Abstract: In einer retrospektiven Studie mit Daten aus 104.962 Primareinsatzen von 28 Luftrettungszentren der ADAC-Luftrettung und des Bundesinnenministeriums vom 01.01.1999 bis 31.12.2003 wurde die Validitat des praklinisch erhobenen NACA-Scores untersucht. Zur Klassifikation der Vitalfunktionen wurde der physiologisch orientierte, fur die praklinische Patientenversorgung konzipierte MEES als Score genutzt. Fur die Beurteilung der Notfallschwere war der kritischste Messwert fur die jeweilige Vitalfunktion aus der praklinischen Versorgungsphase masgebend. Die Ergebnisse zeigen, dass pathologische Messparameter der Vitalfunktionen fur die Einordnung im NACA-Score durch den Notarzt in z. T. mehr als der Halfte der Falle keine Berucksichtigung finden. Selbst eindeutige Verlaufe wie eine Reanimation oder der Tod des Patienten werden nicht korrekt klassifiziert. Auch unbestritten vitalbedrohende Krankheitsbilder wie der akute Myokardinfarkt (Fehleinschatzung: 51,5%), die Lungenembolie (40,1%) oder das Polytrauma (22,5%) werden im NACA-Score nicht als vitalbedrohend (mindestens NACA-Stufe V) eingeordnet. Zusammenfassend muss festgestellt werden, dass in Ubereinstimmung mit der Literatur die Einordnung der Notfallschwere im NACA-Score durch den Notarzt stark subjektiven Einflussen unterliegt. Daraus ergibt sich, dass der NACA-Score fur wissenschaftliche Fragestellungen, zur Qualitatskontrolle und zur retrograden Beurteilung der Einsatzindikation allein ungeeignet ist. Es sollte ein modifizierter NACA-Score erarbeitet werden, der sich auf objektive Messwerte stutzt.

Abstract: The National Advisory Committee for Aeronautics (NACA) score is used by many emergency medical services to assess the severity of prehospital patients. Little is known about its discriminative performance regarding short-term mortality. We retrospectively included adult missions between 2008 and 2014 in a Swiss ground and air-based emergency medical services. We excluded uninjured or dead-on-scene patients. Primary outcome was assessment of the discriminative performance of the NACA score to classify the 48-h vital status of patients. Overall discrimination was quantified using the area under receiver operating characteristic curve (AUC). We also explored the influence of epidemiological characteristics (age and sex), mechanism (trauma or nontrauma) and clinical parameters (respiratory rate, oxygen saturation, heart rate, systolic blood pressure, capillary refill time, and Glasgow Coma Scale) on its discriminative performance. We then assessed the incremental value of these variables in the classification accuracy of a rule based on these variables in addition to the NACA score. We included 11 567 patients out of 11 639 (72 exclusions for missing data). Overall AUC was 0.86. The score was more discriminant for trauma (AUC = 0.95 vs. 0.83), and for younger patients (AUC = 0.91 for 16-59 vs. 0.78 for 84-104 years). Adding age, sex, mechanism, and clinical parameters resulted in a classification rule with higher discriminative performance than NACA score alone (AUC of 0.92 vs. 0.86; P < 0.001). The NACA score is an efficient way to discriminate victims regarding short-term mortality. Its performance can be enhanced by also integrating epidemiological and clinical parameters into an extended classification rule.

Abstract: Several advanced scoring systems have been established for the assessment of patients in clinical intensive care medicine.1 Currently, the widespread use of these systems allows an assessment of outcome, as well as assisting in the optimal choice of treatment settings, for example, time point to admission to the ICU.2 Furthermore, scoring systems can be an advantageous tool for purposes such as quality control and improvement of cost effectiveness.3 Some of these scores have been modified to provide a consistent scoring system in transport medicine, as for example, the rapid acute physiology scoring (RAPS). RAPS, a truncated version of the acute physiology and chronic health evaluation (APACHE II) score, has proved to be a reliable and predictive measurement of patient severity, and physiologic stability, in short distance helicopter transport systems.4,5 As a modified ICU score, RAPS however, is naturally limited, as it solely ranks illness severity, whereas other transport related aspects, such as, specific risk factors, and limitations for aeromedical transport, are not considered.6 RAPS therefore seems to be feasible for short helicopter transport between intensive care units, rather than for international transport. In contrast,patients undergoing long distance interhospital transfer by air ambulance or commercial airline are, if at all, scored by the NACA (National Committee of Aeronautics) score system, which was introduced about 35 years ago during the Vietnam war (Table 1), and last modified in 1976.7 The aim of this score system was a rapid triage of patients evacuated from battlefields, and not the ranking of patients transported between hospitals. Although also modified to accommodate patients suffering from internal diseases, the NACA score system poorly reflects the complex setting of modern interhospital transfer and travel medicine.