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Introduction: This prospective study assessed the efficacy of the predicting power for mortality of two different prehospital scoring systems in trauma with ISS > 14. We present an improved Mainz Emergency Evaluation Scoring system (MEES) in combination with capnometry (MEESc). MEESc is a new scoring system., Patients and Methods: In a prehospital setting, the values of MEES and capnometry (initial and final) were collected from each patient. We added final values of partial pressure of end-tidal CO2 (petCO2) to the MEES scoring system and ranked them from 0 to 2 so that the final maximum sum of this scoring system would be 30 without any change in the minimal score being 10. This study was performed over 4 years (from January 2000 to December 2004) and included 114 consecutive patients hospitalized for major trauma with ISS >14, requiring intubation at the roadside and in whom prehospital petCO2 had been recorded. Patients younger than 16 years and those with severe hypothermia (core temperature less than 30 degrees C) were excluded from the study. There were 81 males and 34 females, age range 16 to 82, mean 41.8 +/- 16.4 years. For every scoring system, the sensitivity, specificity, correct outcome prediction and area under the ROC curve were determined. Results were compared with McNemar's test in Z score. A significant difference was p < 0.05., Results: For prediction of mortality, the best cutoff points were 20 for MEES and 23 for MEESc. The area under the ROC curve was 0.63 for MEES and 0.81 for MEESc (p < 0.05)., Conclusion: There were significant differences between MEES and MEESc. MEESc improved the results of MEES in predicting trauma outcome with ISS > 14. The prehospital use of the improved MEESc system could be an efficient communication protocol between the prehospital and hospital settings.

The paper presents a review study on score systems in current emergency surgery including its classification, application and value, based on the experiences of other authors, the paper suggests application of score systems in different phases of polytraumatized patients treatment (in prehospital, as well as in early and late phases of the inpatient period). The paper also points out certain objective difficulties in everyday scoring of patients at the Department of the Emergency Surgery (daily engagement, computer center, etc.). As a conclusion, the authors present their opinion indicating that in absence of introduction of these systems into the practice, the approach to a polytraumatized patient cannot be adequate.