Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
J Trauma Acute Care Surg. 2013 Jun;74(6):1521-7. doi: 10.1097/TA.0b013e318292158d.
Current infection risk scores are not designed to predict the likelihood of surgical site infection after orthopedic fracture surgery. We hypothesized that the National Nosocomial Infections Surveillance (NNIS) System and the Study on the Efficacy of Nosocomial Infection Control (SENIC) scores are not predictive of infection after orthopedic fracture surgery and that risk factors for infection can be identified and a new score created (Emerg Infect Dis. 2003;9:196-203).
We conducted a secondary analysis of data from a trial involving internal fixation of 235 tibial plateau, pilon, and calcaneus fractures treated between 2007 and 2010 at a Level I trauma center. The predictive value of the NNIS System and SENIC scores was evaluated based on areas under the receiver operating characteristic (ROC) curve. Bivariate and multiple logistic regression analyses were used to build an improved prediction model, creating the Risk of Infection in Orthopedic Trauma Surgery (RIOTS) score. The predictive value of the RIOTS score was evaluated via the ROC curve.
NNIS System and SENIC scores were not predictive of surgical site infection after orthopedic fracture surgery. In our final regression model, the relative odds of infection among patients with AO [Arbeitsgemeinschaft für Osteosynthesefragen] type C3 or Sanders type 4 fractures compared with fractures of lower classification was 5.40. American Society of Anesthesiologists class 3 or higher and body mass index less than 30 were also predictive of infection, with odds ratios of 2.87 and 3.49, respectively. The area under the ROC curve for the RIOTS score was 0.75, significantly higher than the areas for the NNIS System and SENIC scores.
The NNIS System and SENIC scores were not useful in predicting the risk of infection after fixation of fractures. We propose a new score that incorporates fracture classification, American Society of Anesthesiologists classification, and body mass index as predictors of infection.
Prognostic study, level II.
目前的感染风险评分并非用于预测骨科骨折手术后发生手术部位感染的可能性。我们假设国家医院感染监测系统（NNIS）和医院感染控制效果研究（SENIC）评分不能预测骨科骨折手术后的感染，并且可以确定感染的危险因素并创建新的评分（Emerg Infect Dis. 2003;9:196-203）。
我们对 2007 年至 2010 年期间在一家一级创伤中心接受内固定治疗的 235 例胫骨平台、pilon 和跟骨骨折患者进行了一项试验的二次数据分析。根据接受者操作特征（ROC）曲线下的面积评估 NNIS 系统和 SENIC 评分的预测价值。使用二变量和多变量逻辑回归分析来构建改良的预测模型，创建骨科创伤手术感染风险（RIOTS）评分。通过 ROC 曲线评估 RIOTS 评分的预测价值。
NNIS 系统和 SENIC 评分不能预测骨科骨折手术后的手术部位感染。在我们的最终回归模型中，与较低分类的骨折相比，AO（Arbeitsgemeinschaft für Osteosynthesefragen）类型 C3 或 Sanders 类型 4 骨折患者感染的相对风险比为 5.40。美国麻醉医师协会 3 级或更高和体重指数小于 30 也是感染的预测因素，比值比分别为 2.87 和 3.49。RIOTS 评分的 ROC 曲线下面积为 0.75，明显高于 NNIS 系统和 SENIC 评分的面积。
NNIS 系统和 SENIC 评分不能用于预测骨折固定后感染的风险。我们提出了一种新的评分，该评分将骨折分类、美国麻醉医师协会分类和体重指数作为感染预测因子。
预后研究，II 级。
