Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Tripoli, Greece.
J Trauma Nurs. 2022;29(1):34-40. doi: 10.1097/JTN.0000000000000629.
Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned.
The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population.
This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics.
A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113).
In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.
尽管创伤和损伤严重程度评分（TRISS）已被广泛用于创伤死亡率风险调整，但越来越多的人质疑其在当代创伤人群中的适用性。
本研究旨在评估 TRISS 的原始和修订版本的预测性能，并将其与包括希腊创伤人群当前数据的重新校准版本进行比较。
这是一项回顾性队列研究，纳入了 2016 年 1 月至 2018 年 12 月在希腊两家三级医院住院的创伤患者。模型算法是根据重大创伤结局研究系数（TRISSMTOS）、国家创伤数据库系数（TRISSNTDB）和从希腊创伤数据集获得的逻辑回归重新加权系数（TRISSGrTD）计算的。主要终点是院内死亡率。使用区分度和校准统计数据来评估模型的预测能力。
共纳入 8988 例创伤患者，其中 854 例死亡（9.5%）。TRISSMTOS 具有出色的区分度，曲线下面积（AUC）为 0.912（95%CI 0.902-0.923），与 TRISSNTDB 相当（AUC=0.908，95%CI 0.897-0.919，p=0.1195）。两种模型的校准均较差（Hosmer-Lemeshow 检验 p<0.001），倾向于低估几乎所有风险组的死亡率。TRISSGrTD 显著提高了区分度（AUC=0.927，95%CI 0.918-0.936，p<0.0001）和可接受的校准（Hosmer-Lemeshow 检验 p=0.113）。
在本研究的希腊创伤患者队列中，原始 TRISS 的表现不佳，没有证据表明它从最新修订中受益。相比之下，强烈支持使用本地重新校准的版本使 TRISS 适用于死亡率预测和绩效基准。
