老年创伤预后计算器的比较：老年创伤后生活与局限性的预后评估联盟研究
A comparison of prognosis calculators for geriatric trauma: A Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium study.
作者信息
Madni Tarik David, Ekeh Akpofure Peter, Brakenridge Scott C, Brasel Karen J, Joseph Bellal, Inaba Kenji, Bruns Brandon R, Kerby Jeffrey D, Cuschieri Joseph, Mohler M Jane, Nakonezny Paul A, Clark Audra, Imran Jonathan, Wolf Steven E, Paulk M Elizabeth, Rhodes Ramona L, Phelan Herb A
机构信息
From the Department of Surgery (T.D.M.), University of Texas-Southwestern Medical Center, Dallas, Texas; Wright State Physicians, Division of Acute Care Surgery (A.P.E.), Dayton, Ohio; Division of Acute Care Surgery (S.C.B.), University of Florida, Gainesville, Florida; Division of Trauma, Critical Care, and Acute Care Surgery (K.J.B.), Oregon Health Sciences University, Portland, Oregon; Division of Trauma (B.J.), Critical Care, Burn, and Emergency Surgery, University of Arizona, Tucson, Arizona; Division of Acute Care Surgery and Surgical Critical Care (K.I.), University of Southern California, Los Angeles, California; R Adams Cowley Shock Trauma Center at the University of Maryland (B.R.B.), Baltimore, Maryland; Division of Trauma, Burns, and Surgical Critical Care (J.D.K.), UAB Medical Center, Birmingham, Alabama; Division of Trauma, Burn, and Critical Care Surgery (J.C.), University of Washington, Seattle, Washington; Department of Medicine (M.J.M.), University of Arizona, Tucson, Arizona; Division of Biostatistics, Department of Clinical Sciences (P.A.N.), Department of Surgery (A.C., J.I.), Division of Burns/Trauma/Critical Care (S.E.W., H.A.P.), Department of Internal Medicine (M.E.P.), Palliative Medicine, Division of Geriatrics (R.L.R.), Palliative Medicine, University of Texas-Southwestern Medical Center, Dallas, Texas.
出版信息
J Trauma Acute Care Surg. 2017 Jul;83(1):90-96. doi: 10.1097/TA.0000000000001506.
BACKGROUND
The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample.
METHODS
Three Prognostic Assessment of Life and Limitations After Trauma in the Elderly centers not submitting subjects to the GTOS validation study identified subjects aged 65 years to 102 years admitted from 2000 to 2013. GTOS was specified using the formula [GTOS = age + (Injury Severity Score [ISS] × 2.5) + 22 (if transfused packed red cells (PRC) at 24 hours)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 years = 0 and ≥55 years = 1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = -2.5355 + (0.9934 × RTS) + (-0.0651 × ISS) + (-1.1360 × Age)]. TRISS Blunt was specified as [TRISSB = -0.4499 + (0.8085 × RTS Total) + (-0.0835 × ISS) + (-1.7430 × Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and area under the curve.
RESULTS
Demographics (mean + SD) of subjects with complete data (N = 10,894) were age, 78.3 years ± 8.1 years; ISS, 10.9 ± 8.4; RTS = 7.5 ± 1.1; mortality = 6.9%; blunt mechanism = 98.6%; 3.1 % of subjects received PRCs. The penetrating trauma subsample (n = 150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS, 0.065; TRISSB, 0.051; and TRISSP, 0.120. Brier scores were GTOS, 0.052; TRISSB, 0.041; and TRISSP, 0.084. The area under the curves were GTOS, 0.844; TRISSB, 0.889; and TRISSP, 0.897.
CONCLUSION
GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the emergency room or by other observers.
LEVEL OF EVIDENCE
Prognostic, level II.
背景
由九个中心组成的老年创伤后生活与功能预后评估联盟已验证老年创伤结局评分（GTOS）可作为受伤老年人的预后计算器。我们在一个多中心样本中比较了GTOS与创伤损伤严重程度评分（TRISS）的性能。
方法
三个未将受试者纳入GTOS验证研究的老年创伤后生活与功能预后评估中心，确定了2000年至2013年期间收治的65岁至102岁的受试者。GTOS使用公式[GTOS = 年龄 +（损伤严重程度评分[ISS]×2.5）+ 22（如果在24小时内输注了浓缩红细胞（PRC））]进行计算。TRISS使用修订创伤评分（RTS），将年龄进行二分法划分（<55岁 = 0，≥55岁 = 1），并使用1995年更新的β系数进行计算。穿透性TRISS指定为[TRISSP = -2.5355 +（0.9934×RTS）+（-0.0651×ISS）+（-1.1360×年龄）]。钝性TRISS指定为[TRISSB = -0.4499 +（0.8085×RTS总分）+（-0.0835×ISS）+（-1.7430×年龄）]。然后，每个评分在单独的逻辑回归模型中成为唯一的预测因子，以估计死亡概率。使用错误分类率、Brier评分和曲线下面积评估模型性能。
结果
具有完整数据（N = 10,894）的受试者的人口统计学特征（均值±标准差）为：年龄78.3岁±8.1岁；ISS为10.9±8.4；RTS = 7.5±1.1；死亡率 = 6.9%；钝性机制 = 98.6%；3.1%的受试者接受了PRC。穿透性创伤亚组（n = 150）的死亡率较高，为20.0%。模型的错误分类率分别为：GTOS为0.065；TRISSB为0.051；TRISSP为0.120。Brier评分分别为：GTOS为0.052；TRISSB为0.041；TRISSP为0.084。曲线下面积分别为：GTOS为0.844；TRISSB为0.889；TRISSP为0.897。
结论
GTOS和TRISS在预测受伤老年人的死亡概率方面功能相似且准确。GTOS具有单一公式、变量较少且不依赖于在急诊室或由其他观察者收集的数据的优点。
证据级别
预后性，二级。
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