Kuo Spencer C H, Kuo Pao-Jen, Chen Yi-Chun, Chien Peng-Chen, Hsieh Hsiao-Yun, Hsieh Ching-Hua
Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2017 Nov 9;12(11):e0187871. doi: 10.1371/journal.pone.0187871. eCollection 2017.
To compare Exponential Injury Severity Score (EISS) with Injury Severity Score (ISS) and New Injury Severity Score (NISS) in terms of their predictive capability of the outcomes and medical expenses of hospitalized adult trauma patients.
This study was based at a level I trauma center in Taiwan.
Data for 17,855 adult patients hospitalized from January 1, 2009 to December 31, 2015 were retrieved from the Trauma Registry System. The primary outcome was in-hospital mortality. Secondary outcomes were the hospital length of stay (LOS), intensive care unit (ICU) admission rate, ICU LOS, and medical expenses. Chi-square tests were used for categorical variables to determine the significance of the associations between the predictor and outcome variables. Student t-tests were applied to analyze normally distributed data for continuous variables, while Mann-Whitney U tests were used to compare non-normally distributed data.
According to the survival rate-to-severity score relationship curve, we grouped all adult trauma patients based on EISS scores of ≥ 27, 9-26, and < 9. Significantly higher mortality rates were noted in patients with EISS ≥ 27 and those with EISS of 9-26 when compared to patients with EISS < 9; this finding concurred to the findings for groups classified by the ISS and NISS with the cut-off points set between 25 and 16. The hospital LOS, ICU admission rates, and medical expenses for patients with EISS ≥ 27 and patients with EISS of 9-26 were also significantly longer and higher than that of patients with EISS < 9. When comparing the demographics and detailed medical expenses of very severely injured adult trauma patients classified according to ISS, NISS, and EISS, patients with ISS ≥ 25 and NISS ≥ 25 both had significantly lower mortality rates, lower ICU admission rates, and shorter ICU LOS compared to patients with EISS ≥ 27.
EISS 9 and 27 can serve as two cut-off points regarding injury severity, and patients with EISS ≥ 27 have the greatest injury severity. Additionally, these patients have the highest mortality rate, the highest ICU admission rate, and the longest ICU LOS compared to those with ISS ≥ 25 and NISS ≥ 25, suggesting that patients with EISS ≥ 27 have the worst outcome.
比较指数损伤严重度评分（EISS）与损伤严重度评分（ISS）及新损伤严重度评分（NISS）对成年创伤住院患者的预后及医疗费用的预测能力。
本研究基于台湾的一家一级创伤中心。
从创伤登记系统中检索2009年1月1日至2015年12月31日期间住院的17855例成年患者的数据。主要结局是院内死亡率。次要结局包括住院时间（LOS）、重症监护病房（ICU）入住率、ICU住院时间及医疗费用。对分类变量采用卡方检验来确定预测变量与结局变量之间关联的显著性。对连续变量的正态分布数据采用学生t检验进行分析，而非正态分布数据则采用曼-惠特尼U检验进行比较。
根据生存率与严重度评分关系曲线，我们将所有成年创伤患者按EISS评分≥27、9 - 26及<9进行分组。与EISS<9的患者相比，EISS≥27及EISS为9 - 26的患者死亡率显著更高；这一发现与按ISS和NISS分类且截断点设定在25至16之间的分组结果一致。EISS≥27及EISS为9 - 26的患者的住院LOS、ICU入住率及医疗费用也显著长于和高于EISS<9的患者。在比较根据ISS、NISS和EISS分类的极重度成年创伤患者的人口统计学特征及详细医疗费用时，与EISS≥27的患者相比，ISS≥25及NISS≥25的患者死亡率均显著更低、ICU入住率更低且ICU住院时间更短。
EISS的9分和27分可作为损伤严重度的两个截断点，EISS≥27的患者损伤严重度最高。此外，与ISS≥25及NISS≥25的患者相比，这些患者死亡率最高、ICU入住率最高且ICU住院时间最长，表明EISS≥27患者的预后最差。
