Jeong Jin Hee, Park Yong Joo, Kim Dong Hoon, Kim Tae Yun, Kang Changwoo, Lee Soo Hoon, Lee Sang Bong, Kim Seong Chun, Lim Daesung
Department of Emergency Medicine, Gyeongsang National University School of Medicine, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, 52727, Republic of Korea.
Institute of Health Sciences, Gyeongsang National University, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea.
BMC Surg. 2017 Jul 3;17(1):77. doi: 10.1186/s12893-017-0272-4.
Since its introduction, the Revised Trauma Score (RTS) has been widely used to determine the prognosis of trauma patients. Recent studies have revealed a need to change the parameters of the RTS. We have designed a new trauma score (NTS) based on revised parameters, including the adoption of the actual Glasgow Coma Scale (GCS) score instead of a GCS code, the revision of the systolic blood pressure interval used for the code value and the incorporation of peripheral oxygen saturation (SpO) instead of respiratory rate. The purpose of this study was to evaluate the predictive performance of the NTS for in-hospital mortality compared with the RTS and other trauma scores.
This was a prospective observational study using data from the trauma registry of a tertiary hospital. The subjects were selected from patients who arrived at the ED between July 1, 2014, and June 30, 2016, and, for external validation purposes, those who arrived at the ED between July 1, 2011, and June 30, 2013. Demographic data and physiological data were analyzed. NTS models were calculated using logistic regression for GCS score, SBP code values, and SpO. The mortality predictive performance of NTS was compared with that of other trauma scores.
A total of 3263 patients for derivation and 3106 patients for validation were included in the analysis. The NTS showed better discrimination than the RTS (AUC = 0.935 vs. 0.917, respectively, AUC difference = 0.018, p = 0.001; 95% CI, 0.0071-0.0293) and similar discrimination to that of mechanism, Glasgow Coma scale, age, and arterial pressure (MGAP) and the Glasgow Coma Scale, age, and systolic arterial pressure (GAP). In the validation cohort, the global properties of the NTS for mortality prediction were significantly better than those of the RTS (AUC = 0.919 vs. 0.906, respectively; AUC difference = 0.013, p = 0.013; 95% CI, 0.0009-0.0249) and similar to those of the MGAP and GAP.
The NTS predicts in-hospital mortality substantially better than the RTS.
自修订创伤评分（RTS）引入以来，它已被广泛用于确定创伤患者的预后。最近的研究表明有必要改变RTS的参数。我们基于修订后的参数设计了一种新的创伤评分（NTS），包括采用实际格拉斯哥昏迷量表（GCS）评分而非GCS编码，修订用于编码值的收缩压区间，并纳入外周血氧饱和度（SpO）而非呼吸频率。本研究的目的是评估与RTS和其他创伤评分相比，NTS对院内死亡率的预测性能。
这是一项前瞻性观察性研究，使用了一家三级医院创伤登记处的数据。研究对象选自2014年7月1日至2016年6月30日期间抵达急诊科的患者，为进行外部验证，还包括2011年7月1日至2013年6月30日期间抵达急诊科的患者。对人口统计学数据和生理数据进行了分析。使用逻辑回归计算GCS评分、收缩压编码值和SpO的NTS模型。将NTS的死亡率预测性能与其他创伤评分进行了比较。
分析共纳入3263例用于推导的患者和3106例用于验证的患者。NTS显示出比RTS更好的区分度（AUC分别为0.935和0.917，AUC差异 = 0.018，p = 0.001；95% CI，0.0071 - 0.0293），并且与创伤机制、格拉斯哥昏迷量表、年龄和动脉压（MGAP）以及格拉斯哥昏迷量表、年龄和收缩压（GAP）的区分度相似。在验证队列中，NTS用于死亡率预测的整体性能显著优于RTS（AUC分别为0.919和0.906；AUC差异 = 0.013，p = 0.013；95% CI，0.0009 - 0.0249），并且与MGAP和GAP相似。
NTS对院内死亡率的预测明显优于RTS。
