Trauma & Emergency Centre, Prince of Wales Hospital, Hong Kong.
Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong; Trauma Service, Princess of Margaret Hospital, Hong Kong.
Am J Emerg Med. 2022 Oct;60:73-77. doi: 10.1016/j.ajem.2022.07.050. Epub 2022 Jul 25.
A key component of trauma system evaluation is the Injury Severity Score (ISS). The ISS is dependent on the AIS, and as AIS versions are updated this effects the number of patients within a health system which are considered severely injured (ISS >15). This study aims to analyse the changes comparing AIS1998 and AIS2015, and its impact on injury severity scoring and survival prediction model in a major trauma centre.
This retrospective study reviewed all blunt trauma admissions from 1 January 2020 to 31 December 2020 from the trauma registry of Prince of Wales Hospital, Hong Kong. Patients were manually double coded with AIS1998 and AIS2015 by the same experienced trauma nurse who have completed both AIS 1998 and AIS 2015 Courses. AIS patterns and Injury Severity Scores (ISS) derived from AIS 1998 and 2015 were compared using the Wilcoxon Signed Rank Test. The area under the receiving operator curve (AUROC) was compared based on the Trauma and Injury Severity Score (TRISS) model using AIS 1998 and AIS 2015.
739 patients were included. There were 34 deaths within 30 days (30-day mortality rate 4.6%). Patients coded with AIS2015 compared with AIS1998 had significant reductions in the classification of serious, severe and critical categories of AIS, with a substantial increase in the mild and moderate categories. The largest reduction was observed in the head and neck region (Z = -11.018, p < 0.001), followed by the chest (Z = -6.110, p < 0.001), abdomen (Z = -4.221, p < 0.001) and extremity regions (Z = -4.252, p < 0.001). There was a 27% reduction in number of cases with ISS >15 in AIS2015 compared with AIS1998. Rates of 30-day mortality, ICU admission, emergency operation and trauma team activation of ISS > 15 using AIS 1998 were similar to the cut off for New Injury Severity Score (NISS) >12 using AIS 2015. The AUROC from the TRISS (AIS2015) was 0.942, and not different from the AUROC for TRISS (AIS1998) of 0.936. The sensitivity and specificity were 93.9% and 82.1% for TRISS (AIS2015), and 93.9% and 76.0% for TRISS (AIS1998).
Trauma centres should be aware of the impact of the AIS2015 update on the benchmarking of trauma care, and consider the need for updating the ISS cut off for major trauma definitions.
创伤系统评估的一个关键组成部分是损伤严重程度评分（ISS）。ISS 依赖于 AIS，随着 AIS 版本的更新，这会影响到一个卫生系统中被认为严重受伤的患者数量（ISS>15）。本研究旨在分析 AIS1998 和 AIS2015 之间的变化，并分析其对香港威尔士亲王医院创伤登记处 2020 年 1 月 1 日至 2020 年 12 月 31 日期间所有钝器伤入院患者的影响。由同一位经验丰富的创伤护士对患者进行手动双重编码，该护士已完成 AIS1998 和 AIS2015 课程。使用 Wilcoxon 符号秩检验比较 AIS1998 和 2015 衍生的 AIS 模式和损伤严重程度评分（ISS）。根据创伤和损伤严重程度评分（TRISS）模型，使用 AIS1998 和 AIS2015 比较接受者操作特征曲线（AUROC）下的面积。
共纳入 739 例患者。30 天内死亡 34 例（30 天死亡率 4.6%）。与 AIS1998 相比，用 AIS2015 编码的患者，AIS 的严重、严重和危急类别分类显著减少，而轻度和中度类别显著增加。头颈部区域的降幅最大（Z=-11.018，p<0.001），其次是胸部（Z=-6.110，p<0.001）、腹部（Z=-4.221，p<0.001）和四肢区域（Z=-4.252，p<0.001）。与 AIS1998 相比，ISS>15 的病例数减少了 27%。使用 AIS1998 时，ISS>15 的 30 天死亡率、入住 ICU、急诊手术和创伤小组激活率与使用 AIS2015 时的新损伤严重程度评分（NISS）>12 的率相似。TRISS（AIS2015）的 AUROC 为 0.942，与 TRISS（AIS1998）的 AUROC 0.936 无差异。TRISS（AIS2015）的灵敏度和特异性分别为 93.9%和 82.1%，TRISS（AIS1998）的灵敏度和特异性分别为 93.9%和 76.0%。
创伤中心应该意识到 AIS2015 更新对创伤护理基准的影响，并考虑更新主要创伤定义的 ISS 截止值。
