Department of Orthopedics, Trauma and Reconstructive Surgery and Harald Tscherne Laboratory, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Eur J Trauma Emerg Surg. 2024 Jun;50(3):649-656. doi: 10.1007/s00068-022-02035-5. Epub 2022 Jul 10.
Scores are widely used for the assessment of injury severity and therapy guidance in severely injured patients. They differ vastly regarding complexity, applicability, and prognostic accuracy. The objective of this study was to compare well-established with more recently developed trauma scores as well as intensive care unit (ICU) scores.
Retrospective analysis of severely injured patients treated at a level I trauma centre from 2010 to 2015.
Age ≥ 18 years, Injury Severity Score ≥ 16 and ICU treatment. Primary endpoint was in-hospital mortality. Several scores (ISS, APACHE II, RTS, Marshall Score, SOFA, NISS, RISC II, EAC and PTGS) were assessed to determine their predictive quality for mortality. Statistical analysis included correlation analysis and receiver operating characteristic (ROC).
444 patients were included. 71.8% were males, mean age was 51 ± 20.26 years. 97.4% sustained a blunt trauma. The area under the ROC curve (AUROC) revealed RISC II (0.92) as strongest predictor regarding mortality, followed by APACHE II (0.81), Marshall score (0.69), SOFA (0.70), RTS (0.66), NISS (0.62), PTGS (0.61) and EAC (0.60). ISS did not reach statistical significance.
RISC II provided the strongest predictive capability for mortality. In comparison, more simple scores focusing on injury pattern (ISS, NISS), physiological abnormalities (RTS, EAC), or a combination of both (PTGS) only provided inferior mortality prediction. Established ICU scores like APACHE II, SOFA and Marshall score were proven to be helpful tools in severely injured trauma patients.
评分系统广泛用于评估严重创伤患者的损伤严重程度和治疗指导。它们在复杂性、适用性和预后准确性方面存在很大差异。本研究的目的是比较成熟的和最近开发的创伤评分以及重症监护病房（ICU）评分。
回顾性分析 2010 年至 2015 年在 I 级创伤中心治疗的严重创伤患者。
年龄≥18 岁，损伤严重程度评分≥16 分，接受 ICU 治疗。主要终点为院内死亡率。评估了几种评分（ISS、APACHE II、RTS、Marshall 评分、SOFA、NISS、RISC II、EAC 和 PTGS），以确定它们对死亡率的预测质量。统计分析包括相关性分析和受试者工作特征（ROC）分析。
共纳入 444 例患者，男性占 71.8%，平均年龄为 51±20.26 岁，97.4%为钝性创伤。ROC 曲线下面积（AUROC）显示 RISC II（0.92）是死亡率最强的预测指标，其次是 APACHE II（0.81）、Marshall 评分（0.69）、SOFA（0.70）、RTS（0.66）、NISS（0.62）、PTGS（0.61）和 EAC（0.60）。ISS 未达到统计学意义。
RISC II 对死亡率的预测能力最强。相比之下，更简单的评分系统，如仅关注损伤模式（ISS、NISS）、生理异常（RTS、EAC），或两者结合（PTGS），只能提供较差的死亡率预测。成熟的 ICU 评分，如 APACHE II、SOFA 和 Marshall 评分，已被证明是严重创伤患者的有用工具。
