Schluter Philip J, Nathens Avery, Neal Melanie L, Goble Sandra, Cameron Cate M, Davey Tamzyn M, McClure Roderick J
School of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand.
J Trauma. 2010 Apr;68(4):761-70. doi: 10.1097/TA.0b013e3181d3223b.
Currently used Trauma and Injury Severity Score (TRISS) coefficients, which measure probability of survival (PS), were derived from the Major Trauma Outcome Study (MTOS) in 1995 and are now unlikely to be optimal. This study aims to estimate new TRISS coefficients using a contemporary database of injured patients presenting to emergency departments in the United States; and to compare these against the MTOS coefficients.
Data were obtained from the National Trauma Data Bank (NTDB) and the NTDB National Sample Project (NSP). TRISS coefficients were estimated using logistic regression. Separate coefficients were derived from complete case and multistage multiple imputation analyses for each NTDB and NSP dataset. Associated PS over Injury Severity Score values were graphed and compared by age (adult >or=15 years; pediatric <15 years) and injury mechanism (blunt; penetrating) groups. Area under the Receiver Operating Characteristic curves was used to assess coefficients' predictive performance.
Overall 1,072,033 NTDB and 1,278,563 weighted NSP injury events were included, compared with 23,177 used in the original MTOS analyses. Large differences were seen between results from complete case and imputed analyses. For blunt mechanism and adult penetrating mechanism injuries, there were similarities between coefficients estimated on imputed samples, and marked divergences between associated PS estimates and those from the MTOS. However, negligible differences existed between area under the receiver operating characteristic curves estimates because the overwhelming majority of patients had minor trauma and survived. For pediatric penetrating mechanism injuries, variability in coefficients was large and PS estimates unreliable.
Imputed NTDB coefficients are recommended as the TRISS coefficients 2009 revision for blunt mechanism and adult penetrating mechanism injuries. Coefficients for pediatric penetrating mechanism injuries could not be reliably estimated.
目前使用的创伤和损伤严重程度评分（TRISS）系数用于衡量生存概率（PS），它源自1995年的重大创伤结局研究（MTOS），如今可能并非最优。本研究旨在利用美国急诊科就诊的受伤患者的当代数据库来估计新的TRISS系数，并将其与MTOS系数进行比较。
数据来自国家创伤数据库（NTDB）和NTDB国家样本项目（NSP）。使用逻辑回归估计TRISS系数。针对每个NTDB和NSP数据集，分别从完整病例分析和多阶段多重插补分析中得出系数。绘制并比较了不同年龄组（成人≥15岁；儿童＜15岁）和损伤机制组（钝性；穿透性）的损伤严重程度评分值对应的相关PS。采用受试者工作特征曲线下面积来评估系数的预测性能。
总共纳入了1,072,033例NTDB损伤事件和1,278,563例加权NSP损伤事件，而原始MTOS分析中使用了23,177例。完整病例分析和插补分析的结果存在很大差异。对于钝性机制损伤和成人穿透性机制损伤，插补样本估计的系数之间存在相似性，相关PS估计值与MTOS的估计值之间存在明显差异。然而，受试者工作特征曲线下面积估计值之间的差异可忽略不计，因为绝大多数患者为轻度创伤且存活。对于儿童穿透性机制损伤，系数的变异性很大，PS估计值不可靠。
建议将插补后的NTDB系数作为2009年修订版的TRISS系数用于钝性机制和成人穿透性机制损伤。儿童穿透性机制损伤的系数无法可靠估计。
