Hariharan Seetharaman, Chen Deryk, Parker Keith, Figari Asher, Lessey Gayatri, Absolom Denese, James Sela, Fraser Osei, Letsholathebe Chawanga Tracey
Anaesthesia and Intensive Care Unit, The University of the West Indies, St. Augustine, Trinidad, West Indies.
J Emerg Med. 2009 Jul;37(1):85-90. doi: 10.1016/j.jemermed.2007.09.051. Epub 2008 Jun 27.
There have been conflicting reports regarding the applicability of Trauma Injury Severity Score (TRISS) methodology to evaluate trauma care in a developing country setting. The objective of this study was to apply TRISS methodology to evaluate trauma care in the public hospitals of a Caribbean developing country. A prospective, observational study was conducted in the three major general hospitals in Trinidad. Major trauma patients were included. Demographic data, waiting time in the Emergency Department, and nature of injury (blunt or penetrating) were noted. Revised Trauma Score, Injury Severity Score, and Glasgow Coma Scale were applied to all patients on admission. Hospital outcomes were noted. Predicted outcomes were calculated for adult patients using TRISS methodology. M, Z statistics and receiver operating characteristic (ROC) curve analysis were done. There were 326 trauma patients studied, of whom 279 adults were evaluated by the TRISS methodology. Men were more frequently involved in trauma than women; there was more blunt trauma than penetrating trauma. The M statistic was 0.98 and the overall Z statistic was 5.81. The ROC curve analysis showed TRISS to be a fair discriminator in the study case-mix with an area under the curve of 0.82 (95% confidence interval 0.69-0.96). There is a considerable disparity between predicted and observed outcomes when trauma patients are evaluated by the TRISS methodology in a developing country setting.
关于创伤严重度评分（TRISS）方法在发展中国家环境中评估创伤护理的适用性，一直存在相互矛盾的报告。本研究的目的是应用TRISS方法评估加勒比地区一个发展中国家公立医院的创伤护理。在特立尼达的三家主要综合医院进行了一项前瞻性观察研究。纳入了主要创伤患者。记录了人口统计学数据、急诊科等待时间和损伤性质（钝性或穿透性）。所有患者入院时均应用修订创伤评分、损伤严重度评分和格拉斯哥昏迷量表。记录了医院结局。使用TRISS方法计算成年患者的预测结局。进行了M、Z统计和受试者工作特征（ROC）曲线分析。共研究了326例创伤患者，其中279例成年患者通过TRISS方法进行评估。男性比女性更常遭受创伤；钝性创伤比穿透性创伤更多。M统计量为0.98，总体Z统计量为5.81。ROC曲线分析显示，在本研究的病例组合中，TRISS是一个中等的判别指标，曲线下面积为0.82（95%置信区间0.69 - 0.96）。在发展中国家环境中，当用TRISS方法评估创伤患者时，预测结局与观察结局之间存在相当大的差异。
