军事损伤严重程度评分（mISS）：一种比损伤严重程度评分（ISS）更能预测战斗死亡率的指标。

The Military Injury Severity Score (mISS): A better predictor of combat mortality than Injury Severity Score (ISS).

作者信息

Le Tuan D, Orman Jean A, Stockinger Zsolt T, Spott Mary Ann, West Susan A, Mann-Salinas Elizabeth A, Chung Kevin K, Gross Kirby R

机构信息

From the Joint Trauma System (T.D.L., Z.T.S., M.A.S., S.A.W., K.R.G.), US Army Institute of Surgical Research (T.D.L., J.A.O., E.A.M-S, K.K.C.), Fort Sam Houston, Texas.

出版信息

J Trauma Acute Care Surg. 2016 Jul;81(1):114-21. doi: 10.1097/TA.0000000000001032.

DOI:10.1097/TA.0000000000001032

PMID:26958797

Abstract

BACKGROUND

The Military Injury Severity Score (mISS) was developed to better predict mortality in complex combat injuries but has yet to be validated.

METHODS

US combat trauma data from Afghanistan and Iraq from January 1, 2003, to December 31, 2014, from the US Department of Defense Trauma Registry (DoDTR) were analyzed. Military ISS, a variation of the ISS, was calculated and compared with standard ISS scores.Receiver operating characteristic curve, area under the curve, and Hosmer-Lemeshow statistics were used to discriminate and calibrate between mISS and ISS. Wilcoxon-Mann-Whitney, t test and χ tests were used, and sensitivity and specificity calculated. Logistic regression was used to calculate the likelihood of mortality associated with levels of mISS and ISS overall.

RESULTS

Thirty thousand three hundred sixty-four patients were analyzed. Most were male (96.8%). Median age was 24 years (interquartile range [IQR], 21-29 years). Battle injuries comprised 65.3%. Penetrating (39.5%) and blunt (54.2%) injury types and explosion (51%) and gunshot wound (15%) mechanisms predominated. Overall mortality was 6.0%.Median mISS and ISS were similar in survivors (5 [IQR, 2-10] vs. 5 [IQR, 2-10]) but different in nonsurvivors, 30 (IQR, 16-75) versus 24 (IQR, 9-23), respectively (p < 0.0001). Military ISS and ISS were discordant in 17.6% (n = 5,352), accounting for 56.2% (n = 1,016) of deaths. Among cases with discordant severity scores, the median difference between mISS and ISS was 9 (IQR, 7-16); range, 1 to 59. Military ISS and ISS shared 78% variability (R = 0.78).Area under the curve was higher in mISS than in ISS overall (0.82 vs. 0.79), for battle injury (0.79 vs. 0.76), non-battle injury (0.87 vs. 0.86), penetrating (0.81 vs. 0.77), blunt (0.77 vs. 0.75), explosion (0.81 vs. 0.78), and gunshot (0.79 vs. 0.73), all p < 0.0001. Higher mISS and ISS were associated with higher mortality. Compared with ISS, mISS had higher sensitivity (81.2 vs. 63.9) and slightly lower specificity (80.2 vs. 85.7).

CONCLUSION

Military ISS predicts combat mortality better than does ISS.

LEVEL OF EVIDENCE

Prognostic and epidemiologic study, level III.

摘要

背景

军事损伤严重程度评分（mISS）旨在更准确地预测复杂战斗损伤中的死亡率，但尚未得到验证。

方法

分析了2003年1月1日至2014年12月31日期间来自美国国防部创伤登记处（DoDTR）的美国在阿富汗和伊拉克的战斗创伤数据。计算了军事损伤严重程度评分（军事ISS，ISS的一种变体），并与标准ISS评分进行比较。使用受试者工作特征曲线、曲线下面积和Hosmer-Lemeshow统计量来区分和校准mISS与ISS。使用Wilcoxon-Mann-Whitney检验、t检验和χ检验，并计算敏感性和特异性。使用逻辑回归计算与mISS和ISS总体水平相关的死亡可能性。

结果

共分析了30364例患者。大多数为男性（96.8%）。中位年龄为24岁（四分位间距[IQR]，21 - 29岁）。战斗损伤占65.3%。穿透伤（39.5%）和钝性伤（54.2%）类型以及爆炸伤（51%）和枪伤（15%）机制占主导。总体死亡率为6.0%。幸存者的中位mISS和ISS相似（分别为5[IQR，2 - 10]和5[IQR，2 - 10]），但非幸存者不同，分别为30（IQR，16 - 75）和24（IQR，9 - 23）（p < 0.0001）。军事ISS和ISS不一致的情况占17.6%（n = 5352），占死亡病例的56.2%（n = 1016）。在严重程度评分不一致的病例中，mISS和ISS的中位差异为9（IQR，7 - 16）；范围为1至59。军事ISS和ISS的变异度有78%的一致性（R = 0.78）。总体而言，mISS的曲线下面积高于ISS（0.82对0.79），战斗损伤（0.79对0.76）、非战斗损伤（0.87对0.86）、穿透伤（0.81对0.77）、钝性伤（0.77对0.75）、爆炸伤（0.81对0.78）和枪伤（0.79对0.73）的曲线下面积均如此，所有p < 0.0001。较高的mISS和ISS与较高的死亡率相关。与ISS相比，mISS具有更高的敏感性（81.2对63.9）和略低的特异性（80.2对85.7）。