Moon Seong Ho, Kim Jong Woo, Byun Joung Hun, Kim Sung Hwan, Choi Jun Young, Jang In Seok, Lee Chung Eun, Yang Jun Ho, Kang Dong Hun, Kim Ki Nyun, Park Hyun Oh
Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
Medicine (Baltimore). 2017 Oct;96(42):e8317. doi: 10.1097/MD.0000000000008317.
Several scoring systems are commonly used to evaluate severity in patients with traumatic injuries. However, there is no generally accepted standard scoring system to assess the severity of thoracic trauma, specifically in patients who have sustained severe injuries. The present study aimed to evaluate the validity of the trauma and injury severity score (TRISS) and the thorax trauma severity score (TTSS) as predictors of in-hospital mortality in patients with severe thoracic trauma.We conducted a retrospective, consecutive review of the medical records of patients with severe thoracic trauma who were managed at our institution between January 2005 and December 2015. Inclusion criteria were patients with severe thoracic injury (injury severity score > 18) who required intensive care therapy and who had no local or systemic infection. We analyzed the association between the trauma severity scores (TTSS and TRISS) and in-hospital mortality in these patients. We also determined the predictive value of the scores using receiver-operating characteristic (ROC) curves.A total of 228 patients with severe thoracic trauma were included in this study. The in-hospital mortality rate was 21.9%. There was a statistically significant association between the TRISS and in-hospital mortality (P < .001), but the association between the TTSS and in-hospital mortality was not statistically significant (P = .547). The ROC curve demonstrated adequate discrimination, as demonstrated by an area under the curve value of 0.787 for the TRISS. At a cut-off value of 25.9%, the TRISS had a sensitivity of 83.6% and specificity of 73.5% to predict in-hospital mortality.The present study demonstrated that the TRISS, but not the TTSS, can be used to predict in-hospital mortality in patients with severe thoracic trauma; hence, additional prospective studies are required.
几种评分系统通常用于评估创伤患者的严重程度。然而，目前尚无普遍接受的标准评分系统来评估胸部创伤的严重程度，特别是对于遭受严重损伤的患者。本研究旨在评估创伤和损伤严重程度评分（TRISS）和胸部创伤严重程度评分（TTSS）作为严重胸部创伤患者院内死亡率预测指标的有效性。
我们对2005年1月至2015年12月在我院接受治疗的严重胸部创伤患者的病历进行了回顾性、连续性分析。纳入标准为严重胸部损伤（损伤严重程度评分>18）、需要重症监护治疗且无局部或全身感染的患者。我们分析了这些患者的创伤严重程度评分（TTSS和TRISS）与院内死亡率之间的关联。我们还使用受试者工作特征（ROC）曲线确定了评分的预测价值。
本研究共纳入228例严重胸部创伤患者。院内死亡率为21.9%。TRISS与院内死亡率之间存在统计学显著关联（P<0.001），但TTSS与院内死亡率之间的关联无统计学意义（P=0.547）。ROC曲线显示出良好的区分度，TRISS曲线下面积值为0.787。在截断值为25.9%时，TRISS预测院内死亡率的敏感性为83.6%，特异性为73.5%。
本研究表明，TRISS而非TTSS可用于预测严重胸部创伤患者的院内死亡率；因此，需要进行更多的前瞻性研究。
