Department of Industrial Economics and Management, KTH Royal Institute of Technology, Stockholm, Sweden.
Department of Surgery, Seth Gowardhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India.
BMJ Open. 2020 Feb 18;10(2):e032900. doi: 10.1136/bmjopen-2019-032900.
The aim of this study was to evaluate and compare the abilities of clinicians and clinical prediction models to accurately triage emergency department (ED) trauma patients. We compared the decisions made by clinicians with the Revised Trauma Score (RTS), the Glasgow Coma Scale, Age and Systolic Blood Pressure (GAP) score, the Kampala Trauma Score (KTS) and the Gerdin model.
Prospective cohort study.
Three hospitals in urban India.
In total, 7697 adult patients who presented to participating hospitals with a history of trauma were approached for enrolment. The final study sample included 5155 patients. The majority (4023, 78.0%) were male.
The patient outcome was mortality within 30 days of arrival at the participating hospital. A grid search was used to identify model cut-off values. Clinicians and categorised models were evaluated and compared using the area under the receiver operating characteristics curve (AUROCC) and net reclassification improvement in non-survivors (NRI+) and survivors (NRI-) separately.
The differences in AUROCC between each categorised model and the clinicians were 0.016 (95% CI -0.014 to 0.045) for RTS, 0.019 (95% CI -0.007 to 0.058) for GAP, 0.054 (95% CI 0.033 to 0.077) for KTS and -0.007 (95% CI -0.035 to 0.03) for Gerdin . The NRI+ for each model were -0.235 (-0.37 to -0.116), 0.17 (-0.042 to 0.405), 0.55 (0.47 to 0.65) and 0.22 (0.11 to 0.717), respectively. The NRI- were 0.385 (0.348 to 0.4), -0.059 (-0.476 to -0.005), -0.162 (-0.18 to -0.146) and 0.039 (-0.229 to 0.06), respectively.
The findings of this study suggest that there are no substantial differences in discrimination and net reclassification improvement between clinicians and all four clinical prediction models when using 30-day mortality as the outcome of ED trauma triage in adult patients.
ClinicalTrials.gov Registry (NCT02838459).
本研究旨在评估和比较临床医生和临床预测模型在准确分诊急诊科（ED）创伤患者方面的能力。我们将临床医生的决策与修订创伤评分（RTS）、格拉斯哥昏迷评分、年龄和收缩压（GAP）评分、坎帕拉创伤评分（KTS）和 Gerdin 模型进行了比较。
前瞻性队列研究。
印度城市的 3 家医院。
共有 7697 名有创伤史的成年患者被纳入参与医院接受治疗。最终研究样本包括 5155 名患者。大多数（4023 名，78.0%）为男性。
患者结局为入院后 30 天内的死亡率。使用网格搜索来确定模型的截断值。使用接受者操作特征曲线下的面积（AUROCC）以及非幸存者（NRI+）和幸存者（NRI-）的净重新分类改善来评估和比较临床医生和分类模型。
每个分类模型与临床医生之间的 AUROCC 差异分别为 RTS 为 0.016（95%CI-0.014 至 0.045），GAP 为 0.019（95%CI-0.007 至 0.058），KTS 为 0.054（95%CI0.033 至 0.077），Gerdin 为-0.007（95%CI-0.035 至 0.03）。每个模型的 NRI+分别为-0.235（-0.37 至-0.116）、0.17（-0.042 至 0.405）、0.55（0.47 至 0.65）和 0.22（0.11 至 0.717），NRI-分别为 0.385（0.348 至 0.4）、-0.059（-0.476 至-0.005）、-0.162（-0.18 至-0.146）和 0.039（-0.229 至 0.06）。
本研究结果表明，当以 ED 创伤分诊的 30 天死亡率为结局时，临床医生和所有四个临床预测模型在区分度和净重新分类改善方面没有实质性差异。
ClinicalTrials.gov 注册（NCT02838459）。
