Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia.
Department of Public Health, University of Virginia, Charlottesville, Virginia.
Traffic Inj Prev. 2022;23(sup1):S143-S148. doi: 10.1080/15389588.2022.2092101. Epub 2022 Jul 25.
The mechanism of injury (MOI) criteria assist in determining which patients are at high risk of severe injury and would benefit from direct transport to a trauma center. The goal of this study was to determine whether the prognostic performance of the Centers for Disease Control's (CDC) MOI criteria for motor vehicle collisions (MVCs) has changed during the decade since the guidelines were approved. Secondary objectives were to evaluate the performance of these criteria for different age groups and evaluate potential criteria that are not currently in the guidelines.
Data were obtained from NASS and Crash Investigation Sampling System (CISS) for 2000-2009 and 2010-2019. Cases missing injury severity were excluded, and all other missing data were imputed. The outcome of interest was Injury Severity Score (ISS) ≥16. The area under the receiver operator characteristic (AUROC) and 95% confidence intervals (CIs) were obtained from 1,000 bootstrapped samples using national case weights. The AUROC for the existing CDC MOI criteria were compared between the 2 decades. The performance of the criteria was also assessed for different age groups based on accuracy, sensitivity, and specificity. Potential new criteria were then evaluated when added to the current CDC MOI criteria.
There were 150,683 (weighted 73,423,189) cases identified for analysis. There was a small but statistically significant improvement in the AUROC of the MOI criteria in the later decade (2010-2019; AUROC = 0.77, 95% CI [0.76-0.78]) compared to the earlier decade (2000-2009; AUROC = 0.75, 95% CI [0.74-0.76]). The accuracy and specificity did not vary with age, but the sensitivity dropped significantly for older adults (0-18 years: 0.62, 19-54 years: 0.59, ≥55 years: 0.37, and ≥65 years: 0.36). The addition of improved the sensitivity of the existing criteria and was the only potential new criterion to maintain a sensitivity above 0.95.
The MOI criteria for MVCs in the current CDC guidelines still perform well even as vehicle design has changed. However, the sensitivity of these criteria for older adults is much lower than for younger occupants. The addition of improved sensitivity while maintaining high specificity and could be considered as a potential modification to current MOI criteria.
损伤机制（MOI）标准有助于确定哪些患者有严重损伤的高风险，并将受益于直接送往创伤中心。本研究的目的是确定自该指南获得批准以来的十年中，疾病控制与预防中心（CDC）MOI 标准对机动车碰撞（MVC）的预测性能是否发生了变化。次要目标是评估这些标准在不同年龄组的表现，并评估目前不在指南中的潜在标准。
从 NASS 和 Crash Investigation Sampling System（CISS）获得 2000-2009 年和 2010-2019 年的数据。排除了缺失伤害严重程度的病例，并对所有其他缺失数据进行了插补。感兴趣的结局是伤害严重程度评分（ISS）≥16。使用全国病例权重，从 1000 个自举样本中获得接收者操作特征（ROC）曲线下面积（AUROC）和 95%置信区间（CI）。比较了 2 个十年中现有 CDC MOI 标准的 AUROC。还根据准确性、敏感性和特异性评估了这些标准在不同年龄组的表现。然后评估了将潜在的新标准添加到当前 CDC MOI 标准时的表现。
分析中确定了 150683 例（加权 73423189 例）。与较早的十年（2000-2009 年；AUROC=0.75，95%CI[0.74-0.76]）相比，较晚的十年（2010-2019 年；AUROC=0.77，95%CI[0.76-0.78]）中 MOI 标准的 AUROC 略有但具有统计学意义的提高。年龄不影响准确性和特异性，但老年人的敏感性显著下降（0-18 岁：0.62，19-54 岁：0.59，≥55 岁：0.37，≥65 岁：0.36）。添加 提高了现有标准的敏感性，并且是唯一能够保持敏感性高于 0.95 的潜在新标准。
即使车辆设计发生了变化，当前 CDC 指南中的 MVC MOI 标准仍然表现良好。然而，这些标准对老年人的敏感性远低于对年轻乘员的敏感性。添加 提高了敏感性，同时保持了较高的特异性，可以考虑作为对当前 MOI 标准的潜在修改。
