Hong Ki Jeong, Song Kyoung Jun, Shin Sang Do, Ro Young Sun, Park Jeong Ho, Lee Seung Chul, Kim Chu Hyun
Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
Clin Exp Emerg Med. 2020 Dec;7(4):281-289. doi: 10.15441/ceem.19.097. Epub 2020 Dec 31.
The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients.
We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0-14, 15-54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC).
The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944-0.952) in group 1 and 0.950 (0.946-0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803-0.817) and 0.816 (0.809-0.823), respectively.
The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.
创伤和损伤严重程度评分（TRISS）已被用于预测创伤患者的死亡率，并评估创伤护理系统的质量。本研究的目的是开发一种改良的创伤相关损伤严重程度评分（称为TRISS-D），用于预测急性创伤患者的残疾情况。
我们使用了紧急医疗服务收集的数据，并将其录入韩国疾病控制与预防中心的严重创伤数据库。TRISS-D基于年龄类别（0-14岁、15-54岁、≥55岁）、修订创伤评分和损伤严重程度评分。结局指标为严重残疾和残疾恶化。残疾恶化定义为出院时格拉斯哥预后评分低于创伤事件发生前。研究了两种类型的病例：穿透性或钝性损伤患者（第1组）和重度颅脑损伤患者（第2组）。我们通过计算受试者操作特征曲线下面积（AUROC）来评估TRISS-D的鉴别能力。
该数据库包含14791例患者；总体而言，3757例（25%）有严重残疾，6018例（41%）有残疾恶化。对于严重残疾，TRISS-D在第1组中的AUROC（95%置信区间）为0.948（0.944-0.952），在第2组中为0.950（0.946-0.954）。残疾恶化的相应值分别为0.810（0.803-0.817）和0.816（0.809-0.823）。
TRISS-D对严重残疾显示出优异的鉴别能力，对残疾恶化显示出良好的鉴别能力。
