Moini M, Rezaishiraz H, Zafarghandi M R
Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Iran.
J Trauma. 2000 Mar;48(3):503-7. doi: 10.1097/00005373-200003000-00023.
Because of the need to improve the quality of care of trauma patients in our country, we decided to evaluate the epidemiology and find the most powerful tool for prediction of survival. The Trauma and Injury Severity Score (TRISS) has been known as conventional method for this purpose. We planned to test its ability for prediction of survival of our trauma patients, and also we wanted to compare its ability with the New Injury Severity Score (NISS) in combination with Revised Trauma Score (RTS) and age. We used the most suitable model to evaluate the trauma care in our centers.
From the Tehran University data registry on trauma patients of three different hospitals during 1 year, we selected trauma patients admitted to hospital for at least 1 day and all those patients who were declared dead at the emergency department. Epidemiologic description of patients has been given and evaluation of TRISS and (NISS + RTS + age) for prediction of survival has been performed. We determined factors affecting mortality and morbidity, evaluated hospitals, and analyzed patients admitted directly and the patients transferred from other hospitals.
A total of 2,662 patients had complete data necessary for the calculation of probability of survival based on the TRISS method. The population at risk for trauma was the young, especially students and industrial workers. The major mechanisms of trauma were road traffic crashes and falls. The time expenditure and means of transportation as well as the time of stay in emergency department all seemed to be far less than optimal. We found that TRISS has higher performance than (NISS + RTS + age).
Based on our descriptive findings, we proposed some suggestions that seem to be necessary for improvement of trauma care in our centers. Among them were improved measures for prehospital service, and emergency department and other health care units of our centers. The findings of this study suggest that conducting trauma surgery training programs and direct transportation to trauma centers can improve the outcome of trauma patients. We conclude that small sample size, mixing penetrating trauma cases with blunt trauma cases, and differences in the mechanism of trauma between study populations may be responsible for the difference between our results and others.
由于我国需要提高创伤患者的护理质量，我们决定评估流行病学情况并找到预测生存的最有效工具。创伤和损伤严重程度评分（TRISS）一直是用于此目的的传统方法。我们计划测试其预测我国创伤患者生存的能力，并且还想将其与新损伤严重程度评分（NISS）结合修订创伤评分（RTS）和年龄的能力进行比较。我们使用最合适的模型来评估我们中心的创伤护理情况。
从德黑兰大学关于三家不同医院1年内创伤患者的数据登记处，我们选择入院至少1天的创伤患者以及所有在急诊科被宣布死亡的患者。给出了患者的流行病学描述，并对TRISS以及（NISS + RTS + 年龄）预测生存的情况进行了评估。我们确定了影响死亡率和发病率的因素，评估了医院，并分析了直接入院的患者和从其他医院转来的患者。
共有2662例患者拥有基于TRISS方法计算生存概率所需的完整数据。创伤的高危人群是年轻人，尤其是学生和产业工人。创伤的主要机制是道路交通事故和跌倒。时间花费、交通方式以及在急诊科的停留时间似乎都远非最佳。我们发现TRISS的表现优于（NISS + RTS + 年龄）。
基于我们的描述性研究结果，我们提出了一些似乎对改善我们中心的创伤护理有必要的建议。其中包括改进院前服务措施以及我们中心的急诊科和其他医疗保健单位。本研究结果表明开展创伤外科培训项目和直接转运至创伤中心可改善创伤患者的结局。我们得出结论，样本量小、穿透性创伤病例与钝性创伤病例混合以及研究人群之间创伤机制的差异可能是我们的结果与其他研究结果存在差异的原因。
