School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, M516 The University of Western Australia, Crawley, WA 6009, Australia.
Scand J Trauma Resusc Emerg Med. 2012 Sep 10;20:63. doi: 10.1186/1757-7241-20-63.
Many injury severity scoring tools have been developed over the past few decades. These tools include the Injury Severity Score (ISS), New ISS (NISS), Trauma and Injury Severity Score (TRISS) and International Classification of Diseases (ICD)-based Injury Severity Score (ICISS). Although many studies have endeavored to determine the ability of these tools to predict the mortality of injured patients, their results have been inconsistent. We conducted a systematic review to summarize the predictive performances of these tools and explore the heterogeneity among studies. We defined a relevant article as any research article that reported the area under the Receiver Operating Characteristic curve as a measure of predictive performance. We conducted an online search using MEDLINE and Embase. We evaluated the quality of each relevant article using a quality assessment questionnaire consisting of 10 questions. The total number of positive answers was reported as the quality score of the study. Meta-analysis was not performed due to the heterogeneity among studies. We identified 64 relevant articles with 157 AUROCs of the tools. The median number of positive answers to the questionnaire was 5, ranging from 2 to 8. Less than half of the relevant studies reported the version of the Abbreviated Injury Scale (AIS) and/or ICD (37.5%). The heterogeneity among the studies could be observed in a broad distribution of crude mortality rates of study data, ranging from 1% to 38%. The NISS was mostly reported to perform better than the ISS when predicting the mortality of blunt trauma patients. The relative performance of the ICSS against the AIS-based tools was inconclusive because of the scarcity of studies. The performance of the ICISS appeared to be unstable because the performance could be altered by the type of formula and survival risk ratios used. In conclusion, high-quality studies were limited. The NISS might perform better in the mortality prediction of blunt injuries than the ISS. Additional studies are required to standardize the derivation of the ICISS and determine the relative performance of the ICISS against the AIS-based tools.
过去几十年已经开发了许多创伤严重程度评分工具。这些工具包括损伤严重程度评分（ISS）、新型损伤严重程度评分（NISS）、创伤和损伤严重程度评分（TRISS）以及基于国际疾病分类（ICD）的损伤严重程度评分（ICISS）。尽管许多研究都致力于确定这些工具预测创伤患者死亡率的能力，但结果并不一致。我们进行了一项系统评价，以总结这些工具的预测性能，并探讨研究之间的异质性。我们将任何报告接收者操作特征曲线下面积作为预测性能衡量标准的研究文章定义为相关文章。我们使用 MEDLINE 和 Embase 进行了在线搜索。我们使用由 10 个问题组成的质量评估问卷评估了每篇相关文章的质量。报告的总阳性答案数作为研究的质量评分。由于研究之间存在异质性，因此未进行荟萃分析。我们确定了 64 篇相关文章，其中工具的 AUROC 为 157 个。问卷的阳性答案中位数为 5，范围为 2 至 8。不到一半的相关研究报告了简明损伤量表（AIS）和/或 ICD 的版本（37.5%）。研究数据中原始死亡率的广泛分布可以观察到研究之间的异质性，范围从 1%到 38%。当预测钝性创伤患者的死亡率时，NISS 大多被报告为比 ISS 表现更好。由于研究数量稀少，ICSS 相对于基于 AIS 的工具的相对性能尚无定论。由于使用的公式类型和生存风险比不同，ICISS 的性能似乎不稳定。总之，高质量的研究有限。NISS 可能在预测钝性损伤的死亡率方面比 ISS 表现更好。需要进一步的研究来规范 ICISS 的推导，并确定 ICISS 相对于基于 AIS 的工具的相对性能。
