Shanti Christina M, Tyburski James G, Rishell Kathryn B, Wilson Robert F, Lozen Yvonne, Seibert Cathy, Steffes Christopher, Carlin Arthur M
Department of Surgery, Detroit Receiving Hospital, 6C-University Health Center, Detroit, Michigan 48201, USA.
Am Surg. 2003 Mar;69(3):257-60; discussion 260.
Trauma deaths at our institution are evaluated by a multidisciplinary trauma committee. The purpose of this study was to evaluate preventable trauma deaths (PRDs) as determined by our review committee and correlate them with the Revised Trauma Score and Injury Severity Score (TRISS) probability of survival (PS). A total of 10,002 patients were identified. The PS was calculated using the TRISS method. The Z scores were calculated and the predicted number of deaths was established. The actual number of deaths was compared with the predicted number of deaths. PRDs were compared with the actual and predicted deaths. The Z score was 0.79, which meant we observed more deaths than predicted by TRISS. We had 281 deaths compared with 271 deaths predicted by TRISS. Peer review characterized 45 deaths as preventable. Although we performed well when our outcomes were compared with TRISS predicted outcomes our PRD rate was higher. The higher the PS the more likely the death was found preventable by peer review. We conclude that for our patient population the peer review process is very sensitive and may be more discerning in identifying PRD than TRISS.
我们机构的创伤死亡病例由一个多学科创伤委员会进行评估。本研究的目的是评估由我们的审查委员会确定的可预防创伤死亡（PRD），并将其与修订创伤评分和损伤严重度评分（TRISS）生存概率（PS）相关联。共识别出10002例患者。使用TRISS方法计算PS。计算Z分数并确定预测死亡数。将实际死亡数与预测死亡数进行比较。将PRD与实际死亡数和预测死亡数进行比较。Z分数为0.79，这意味着我们观察到的死亡人数比TRISS预测的更多。我们有281例死亡，而TRISS预测的死亡数为271例。同行评审将45例死亡判定为可预防的。尽管将我们的结果与TRISS预测结果进行比较时我们表现良好，但我们的PRD率更高。PS越高，通过同行评审发现死亡可预防的可能性就越大。我们得出结论，对于我们的患者群体，同行评审过程非常敏感，在识别PRD方面可能比TRISS更具辨别力。
