Schluter Philip J, Cameron Cate M, Davey Tamzyn M, Civil Ian, Orchard Jodie, Dansey Rangi, Hamill James, Naylor Helen, James Carolyn, Dorrian Jenny, Christey Grant, Pollard Cliff, McClure Rod J
School of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand.
N Z Med J. 2009 Sep 11;122(1302):65-78.
To develop and assess the predictive capabilities of a statistical model that relates routinely collected Trauma Injury Severity Score (TRISS) variables to length of hospital stay (LOS) in survivors of traumatic injury.
Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until discharge from Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Cubic-root transformed LOS was analysed using two-level mixed-effects regression models.
1498 eligible patients were identified, 1446 (97%) injured from a blunt mechanism and 52 (3%) from a penetrating mechanism. For blunt mechanism trauma, 1096 (76%) were male, average age was 37 years (range: 15-94 years), and LOS and TRISS score information was available for 1362 patients. Spearman's correlation and the median absolute prediction error between LOS and the original TRISS model was p=0.31 and 10.8 days, respectively, and between LOS and the final multivariable two-level mixed-effects regression model was p=0.38 and 6.0 days, respectively. Insufficient data were available for the analysis of penetrating mechanism models.
Neither the original TRISS model nor the refined model has sufficient ability to accurately or reliably predict LOS. Additional predictor variables for LOS and other indicators for morbidity need to be considered.
建立并评估一个统计模型的预测能力，该模型将常规收集的创伤损伤严重程度评分（TRISS）变量与创伤幸存者的住院时间（LOS）相关联。
对2002年至2006年间在奥克兰市、米德尔莫尔、怀卡托或北岸医院遭受严重创伤并存活至出院的成年人进行回顾性队列研究。使用二级混合效应回归模型分析立方根转换后的住院时间。
确定了1498名符合条件的患者，其中1446名（97%）因钝性机制受伤，52名（3%）因穿透性机制受伤。对于钝性机制创伤，1096名（76%）为男性，平均年龄为37岁（范围：15 - 94岁），1362名患者可获得住院时间和TRISS评分信息。住院时间与原始TRISS模型之间的Spearman相关性和中位绝对预测误差分别为p = 0.31和10.8天，住院时间与最终多变量二级混合效应回归模型之间的Spearman相关性和中位绝对预测误差分别为p = 0.38和6.0天。穿透性机制模型分析的数据不足。
原始TRISS模型和改进模型都没有足够的能力准确或可靠地预测住院时间。需要考虑住院时间的其他预测变量和其他发病率指标。
