Vles Wouter J, Steyerberg Ewout W, Meeuwis J Dik, Leenen Loek P H
Department of Surgery, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands.
Injury. 2004 Aug;35(8):725-33. doi: 10.1016/j.injury.2003.09.006.
Although mortality is an important outcome parameter for pre-hospital trauma care, it is influenced by many factors other than pre-hospital trauma care alone. We therefore studied an alternative method to evaluate pre-hospital trauma care by calculating the change in probability of survival (Ps) according to the TRISS methodology, before and directly after the pre-hospital trauma care. Correlations between patient characteristics and a change in Ps were assessed. Further, required sample sizes were calculated for an 80% power to detect a hypothetical 3% reduction in mortality and the corresponding change in Ps. In 140 of 191 patients with an Injury Severity Score > or =16, the Ps did not change. In 36, the Ps increased and in 15 patients, the Ps decreased. Between these three groups, significant differences were found in Revised Trauma Score and age, but no clear differences in Injury Severity Score or mortality. A 3% difference in mortality would require 6800 patients, in contrast to 3500 when the change in Ps was the primary outcome parameter. A change in Ps is a promising outcome parameter for a more efficient evaluation of pre-hospital trauma care. A good collaboration is, however, required between ambulance services and the trauma center for reliable registration.
虽然死亡率是院前创伤护理的一个重要结果参数，但它受到许多因素的影响，而不仅仅是院前创伤护理本身。因此，我们研究了一种替代方法，通过根据TRISS方法计算院前创伤护理前后生存概率（Ps）的变化来评估院前创伤护理。评估了患者特征与Ps变化之间的相关性。此外，计算了所需的样本量，以80%的检验效能来检测假设的3%的死亡率降低以及相应的Ps变化。在191例损伤严重度评分≥16的患者中，140例患者的Ps没有变化。36例患者的Ps升高，15例患者的Ps降低。在这三组之间，修订创伤评分和年龄存在显著差异，但损伤严重度评分或死亡率没有明显差异。死亡率有3%的差异需要6800例患者，相比之下，当Ps的变化作为主要结果参数时则需要3500例患者。Ps的变化是一个有前景的结果参数，可用于更有效地评估院前创伤护理。然而，救护服务机构和创伤中心之间需要良好的协作以进行可靠的登记。
