Balogh Z, Offner P J, Moore E E, Biffl W L
Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 80204, USA.
J Trauma. 2000 Apr;48(4):624-7; discussion 627-8. doi: 10.1097/00005373-200004000-00007.
The Injury Severity Score (ISS) has been observed consistently to be a robust predictor of postinjury multiple organ failure (MOF). However, the ISS fails to account for multiple injuries to the same body region. Recently, the "new" ISS (NISS) has been proposed to address this shortcoming. Preliminary studies suggest the NISS is superior to the ISS in predicting trauma mortality. Our purpose was to determine whether the NISS is a better predictor of postinjury MOF than the ISS.
A total of 558 patients admitted to our Level I trauma center with ISS > 15, age > 15 years, and survival > 48 hours were prospectively identified; 101 (18%) developed postinjury MOF. Data characterizing postinjury MOF were collected, and the NISS was calculated retrospectively. The ISS and NISS were compared as univariate predictors of MOF. Multivariate analysis was used to determine whether substitution of NISS for ISS resulted in a superior predictive model.
In 295 patients (53%), the NISS was greater than the ISS. This subgroup of patients experienced a greater frequency of MOF (26.7% vs. 8.3%, p < 0.0001), a higher mortality (12.8% vs. 4.9%, p < 0.001), and a higher early transfusion requirement (6.7 U vs. 3.6 U, p < 0.0001) compared with the group in which NISS equaled ISS. Moreover, the NISS yielded better separation between patients with and without MOF reflected by the greater difference in median NISS scores compared with ISS scores. The multivariate predictive model, including NISS, showed a better goodness of fit compared with the same model that included ISS.
The NISS is superior to the ISS in the prediction of postinjury MOF. This measure of tissue injury severity should replace the ISS in trauma research.
损伤严重度评分（ISS）一直被认为是伤后多器官功能衰竭（MOF）的可靠预测指标。然而，ISS未考虑同一身体区域的多处损伤。最近，有人提出了“新”ISS（NISS）以解决这一缺陷。初步研究表明，NISS在预测创伤死亡率方面优于ISS。我们的目的是确定NISS在预测伤后MOF方面是否比ISS更好。
前瞻性地确定了558例入住我们一级创伤中心的患者，这些患者ISS>15、年龄>15岁且存活时间>48小时；其中101例（18%）发生了伤后MOF。收集了伤后MOF的相关数据，并回顾性计算了NISS。将ISS和NISS作为MOF的单变量预测指标进行比较。采用多变量分析来确定用NISS替代ISS是否能产生更好的预测模型。
在295例患者（53%）中，NISS大于ISS。与NISS等于ISS的组相比，该亚组患者MOF发生率更高（26.7%对8.3%，p<0.0001）、死亡率更高（12.8%对4.9%，p<0.001）以及早期输血需求量更高（6.7单位对3.6单位，p<0.0001）。此外，与ISS评分相比，NISS在有和没有MOF的患者之间产生了更好的区分，这体现在NISS中位数评分的差异更大。与包含ISS的相同模型相比，包含NISS的多变量预测模型显示出更好的拟合优度。
NISS在预测伤后MOF方面优于ISS。这种组织损伤严重程度的测量方法应在创伤研究中取代ISS。
