Kuwabara Kazuaki, Matsuda Shinya, Imanaka Yuichi, Fushimi Kiyohide, Hashimoto Hideki, Ishikawa Koichi B, Horiguchi Hiromasa, Hayashida Kenshi, Fujimori Kenji, Ikeda Shunya, Yasunaga Hideo
Department of Health Care Administration and Management, School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Trauma. 2010 Feb;68(2):463-70. doi: 10.1097/TA.0b013e3181a60275.
Injury Severity Score (ISS) is commonly used in prediction models and risk adjustment for mortality. However, few studies have assessed the relationship of ISS to outcomes such as resource use. To test the utility of ISS for investigation of the quality of trauma care, we evaluated the impact of ISS on resource utilization and mortality.
Of 1,895,249 cases from a Japanese administrative database in 2006, 13,627 trauma patients with ISS were analyzed. Variables included demographics, ISS, number and locations of injured organs, comorbidities, diagnostic and therapeutic procedures recorded during hospitalization, and hospital type. Dependent variables were length of stay (LOS), total charges (TC), initial 48-hour TC, high outliers of LOS or TC, and mortality. Multivariate analyses were used to measure the impact of ISS.
ISS 1 to 9 was most frequent (85.5%) and blunt injury occurred in 93.7% of patients. With increasing ISS, the mortality rate rose to 27.2% at ISS >or=36. LOS was higher at ISS >or=36 whereas TC was higher at 25 to 35. After controlling for study variables, rehabilitation was most strongly associated with LOS, TC, and LOS outliers. ISS 25 to 35 affected initial 48-hour TC most, while ventilation affected mortality most. "Abdomen, pelvic organs" and ISS 25 to 35 or >or=36 were more strongly associated with outcomes.
Specific ISS and injured organs may be used to estimate resource use or mortality for monitoring quality of trauma care. To integrate a more efficient system of trauma care, variations in resource input among hospitals should be investigated.
损伤严重度评分（ISS）常用于预测模型和死亡率的风险调整。然而，很少有研究评估ISS与诸如资源利用等结果之间的关系。为了测试ISS在创伤护理质量调查中的效用，我们评估了ISS对资源利用和死亡率的影响。
对2006年日本行政数据库中的1,895,249例病例进行分析，其中13,627例有ISS的创伤患者纳入研究。变量包括人口统计学特征、ISS、受伤器官的数量和位置、合并症、住院期间记录的诊断和治疗程序以及医院类型。因变量为住院时间（LOS）、总费用（TC）、最初48小时的TC、LOS或TC的高异常值以及死亡率。采用多变量分析来衡量ISS的影响。
ISS 1至9最为常见（85.5%），93.7%的患者为钝性损伤。随着ISS增加，当ISS≥36时死亡率升至27.2%。ISS≥36时LOS较高，而25至35时TC较高。在控制研究变量后，康复与LOS、TC和LOS异常值的相关性最强。ISS 25至35对最初48小时的TC影响最大，而通气对死亡率影响最大。“腹部、盆腔器官”以及ISS 25至35或≥36与结果的相关性更强。
特定的ISS和受伤器官可用于估计资源利用或死亡率，以监测创伤护理质量。为了整合更高效的创伤护理系统，应调查医院之间资源投入的差异。
