Yadollahi Mahnaz, Kashkooe Ali, Rezaiee Reza, Jamali Kazem, Niakan Mohammad Hadi
Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Bull Emerg Trauma. 2020 Jan;8(1):27-33. doi: 10.29252/beat-080105.
To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale.
In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome.
Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants' mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, CI [2.38-18.16]), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5.
Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.
比较损伤严重程度评分作为创伤患者死亡率预测指标，以寻找最佳评分系统。
在2017年3月至9月进行的一项前瞻性队列研究和系统随机抽样中，纳入了13岁以上的创伤患者。调查变量包括年龄、性别、收缩压、心率、呼吸频率、受伤身体部位、格拉斯哥昏迷量表（GCS）、损伤严重程度评分（ISS）、修订创伤评分（RTS）、创伤损伤严重程度评分（TRISS）及结局。
共随访了1410例创伤患者，其中68.5%为男性。参与者的平均年龄为43.5±20.88岁。在调整混杂效应后，60岁以上（OR=7.38，CI[3.91 - 13.93]）、GCS<8（OR=6.5，CI[2.38 - 18.16]）、RTS<7.6（OR=6.04，CI[2 - 13.7]）以及TRISS<0.9（OR=3.09，CI[1.39 - 6.88]）被确定为院内死亡的最显著预测变量。受试者工作特征（ROC）曲线结果显示，与其他评估的测试相比，TRISS的曲线下面积最高。此外，TRISS对于高于96.15的分数具有最高的敏感性和特异性。相比之下，对于高于5.5的分数，GCS的敏感性和特异性降低。
我们的结果表明，TRISS、RTS、GCS和ISS都是评估创伤患者预后、死亡率和可能并发症的非常有效的方法；因此，建议使用这些损伤评估和评分系统以促进治疗。TRISS、RTS和ISS的敏感性几乎相同且高于GCS，但GCS具有最高的特异性。最后，TRISS被选为预测死亡率最有效的评分系统。
