Lavoie André, Moore Lynne, LeSage Natalie, Liberman Moishe, Sampalis John S
Centre hospitalier affilié universitaire de Québec, Enfant-Jésus Hospital, Quebec City, Quebec, Canada.
J Trauma. 2004 Jun;56(6):1312-20. doi: 10.1097/01.ta.0000075342.36072.ef.
The purpose of this study was to determine whether the New Injury Severity Score (NISS) is a better predictor of mortality than the Injury Severity Score (ISS) in general and in subgroups according to age, penetrating trauma, and body region injured.
The study population consisted of 24,263 patients from three urban Level I trauma centers in the province of Quebec, Canada. Discrimination and calibration of NISS and ISS models were compared using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow statistics.
NISS showed better discrimination than ISS (area under the ROC curve = 0.827 vs. 0.819; p = 0.0006) and improved calibration (Hosmer-Leme-show = 62 vs. 112). The advantage of the NISS over the ISS was particularly evident among patients with head/neck injuries (area under the ROC curve = 0.819 vs. 0.784; p < 0.0001; Hosmer-Lemeshow = 59 vs. 350).
The NISS is a more accurate predictor of in-hospital death than the ISS and should be chosen over the ISS for case-mix control in trauma research, especially in certain subpopulations such as head/neck-injured patients.
本研究旨在确定在总体人群以及根据年龄、穿透性创伤和受伤身体部位划分的亚组中，新损伤严重程度评分（NISS）是否比损伤严重程度评分（ISS）更能准确预测死亡率。
研究人群包括来自加拿大魁北克省三个城市一级创伤中心的24,263名患者。使用受试者工作特征（ROC）曲线和Hosmer-Lemeshow统计量比较NISS和ISS模型的区分度和校准度。
NISS的区分度优于ISS（ROC曲线下面积=0.827对0.819；p = 0.0006），校准度也有所改善（Hosmer-Lemeshow=62对112）。NISS相对于ISS的优势在头部/颈部受伤患者中尤为明显（ROC曲线下面积=0.819对0.784；p < 0.0001；Hosmer-Lemeshow=59对350）。
与ISS相比，NISS是更准确的院内死亡预测指标，在创伤研究中进行病例组合控制时，应选择NISS而非ISS，尤其是在某些亚人群中，如头部/颈部受伤患者。
