Murphy J G, Cayten C G, Stahl W M
Institute for Trauma and Emergency Care, New York Medical College, Valhalla.
Am J Emerg Med. 1990 Nov;8(6):484-91. doi: 10.1016/0735-6757(90)90147-r.
The injury severity score (ISS) and age have been used retrospectively to control for trauma severity. Other control variables such as the revised trauma score (RTS) and the TRISS method (which estimates the probability of survival for each patient) additionally require that values of blood pressure, Glasgow coma scale, and respiratory rate, be recorded in the emergency department. The authors question when the RTS, ISS, the ISS and age, or the probability of survival calculated using the TRISS method should be used to control for severity of injuries in trauma research. Relations between predictor variables and (1) survival to hospital discharge, (2) hospital length of stay for survivors, and (3) length of ICU stay were compared by cause of injury: penetrating, motor vehicle accident, low fall, or other blunt. Data were collected over 12 months for 2,914 consecutive adult patients who died or stayed in five nontrauma and three trauma centers for 48 hours or more. For survival, the false-negative rates of probability of survival calculated using the TRISS method were approximately half that of the ISS and age; no variable adequately explained survival among those with low falls. Combinations of ISS, RTS, and age explained the most variation in lengths of hospital stay among survivors, while ISS explained the most variation in lengths of intensive care unit (ICU) stay. Researchers should consider the ISS with RTS and age to control for severity when lengths of hospital or ICU stay are studied. The TRISS method should be used in studies of survival. In both cases, the RTS which requires data collection in the emergency department must be calculated.
损伤严重度评分（ISS）和年龄已被用于回顾性地控制创伤严重程度。其他控制变量，如修正创伤评分（RTS）和TRISS方法（该方法估计每个患者的生存概率），还要求在急诊科记录血压、格拉斯哥昏迷量表和呼吸频率的值。作者们质疑，在创伤研究中，何时应使用RTS、ISS、ISS与年龄，或使用TRISS方法计算的生存概率来控制损伤的严重程度。通过损伤原因比较预测变量与（1）存活至出院、（2）存活者的住院时间和（3）重症监护病房（ICU）住院时间之间的关系：穿透伤、机动车事故、低跌落伤或其他钝性伤。对连续2914例成年患者进行了为期12个月的数据收集，这些患者死亡或在五个非创伤中心和三个创伤中心住院48小时或更长时间。对于生存情况，使用TRISS方法计算的生存概率的假阴性率约为ISS和年龄的一半；没有变量能充分解释低跌落伤患者的生存情况。ISS、RTS和年龄的组合解释了存活者住院时间的最大差异，而ISS解释了重症监护病房（ICU）住院时间的最大差异。在研究住院或ICU住院时间时，研究人员应考虑将ISS与RTS和年龄结合起来以控制严重程度。在生存研究中应使用TRISS方法。在这两种情况下，都必须计算需要在急诊科收集数据的RTS。
