Moore Lynne, Lavoie André, LeSage Natalie, Abdous Belkacem, Bergeron Eric, Liberman Moishe, Emond Marcel
Centre hospitalier affilié universitaire de Québec, Enfant-Jésus Hospital, Quebec City, Canada.
J Trauma. 2006 Feb;60(2):305-11. doi: 10.1097/01.ta.0000200840.89685.b0.
To validate the accuracy of the Revised Trauma Score (RTS) and its components for predicting in-hospital mortality.
Analyses were based on 22,388 patients from the trauma registries of three urban Level I trauma centers in the province of Quebec, Canada. The accuracy of RTS coded variables for the Glasgow Coma Score (GCSc), Systolic Blood Pressure (SBPc), and Respiratory Rate (RRc) for predicting mortality was evaluated in logistic regression models with measures of discrimination and model fit and compared with Fractional Polynomial (FP) transformations of each component.
RTS coded variables were associated with sparse data distributions and did not accurately represent the relation of GCS, SBP, and RR to mortality. FP models were always associated with significantly better discrimination (all p < 0.00001) and model fit. Survival probability estimates generated by the model with FP transformations were significantly different to those generated by the model with RTS-coded variables.
The RTS in its present form does not accurately describe the relation of GCS, SBP, and RR to mortality. FP transformation would improve the accuracy of predicted survival probabilities used for performance evaluation and may improve control of confounding caused by of physiologic severity case mix in trauma research.
验证修订创伤评分（RTS）及其各组成部分预测院内死亡率的准确性。
分析基于来自加拿大魁北克省三个城市一级创伤中心创伤登记处的22388例患者。在具有判别力和模型拟合度测量的逻辑回归模型中，评估格拉斯哥昏迷评分（GCSc）、收缩压（SBPc）和呼吸频率（RRc）的RTS编码变量预测死亡率的准确性，并与各组成部分的分数多项式（FP）转换进行比较。
RTS编码变量与稀疏数据分布相关，不能准确反映格拉斯哥昏迷评分、收缩压和呼吸频率与死亡率的关系。FP模型始终具有显著更好的判别力（所有p<0.00001）和模型拟合度。由FP转换模型生成的生存概率估计值与由RTS编码变量模型生成的估计值显著不同。
目前形式的RTS不能准确描述格拉斯哥昏迷评分、收缩压和呼吸频率与死亡率的关系。FP转换将提高用于性能评估的预测生存概率的准确性，并可能改善创伤研究中由生理严重程度病例组合引起的混杂因素的控制。
