Division of Acute Care Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA.
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Am Surg. 2023 Oct;89(10):4077-4083. doi: 10.1177/00031348231175501. Epub 2023 May 15.
The Trauma and Injury Severity Score (TRISS) is widely used to predict mortality in trauma patients, but its performance metrics have not been analyzed for early vs later deaths. Therefore, we aimed to investigate the impact of time to death on the accuracy of TRISS.
Patients from 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database were included. We compared predicted survival by TRISS using the areas under receiver operating characteristic curves (AUCs) and calibration curves between different cut-off times and subgroups. We further compared early (≤72 hr) and late (>72 hr) deaths based on mechanisms and severity.
Among the 1,180,745 patients, the total mortality rate was 6.4%, with 59% early deaths and 41% late deaths. The AUC of TRISS for all patients was .919 (95% CI: .918-.921) for ≤72 hr survival and .845 (95% CI: .843-.848) for >72 hr survival. Significant discrepancies in AUCs between the early and late death groups existed in all cohorts based on blunt/penetrating mechanisms and severity. TRISS predicted well in early survival of penetrating injury but was less reliable in late survival of penetrating injury and all blunt injury. TRISS tended to underestimate survival, particularly for patients with lower probability of survival, with increased discrepancies seen for predicting late deaths.
The predictive ability of TRISS varies significantly based on the timing of deaths and key injury factors. TRISS may be best utilized in predicting early survival in penetrating injury, but its reliability and accuracy diminish when predicting late deaths for all kinds of injury.
创伤和损伤严重程度评分（TRISS）广泛用于预测创伤患者的死亡率，但尚未分析其用于早期和晚期死亡的预测性能指标。因此，我们旨在研究死亡时间对 TRISS 准确性的影响。
纳入 2013 年至 2018 年美国外科医师学会创伤质量改进计划数据库中的患者。我们通过比较不同截断时间和亚组的接受者操作特征曲线（AUC）和校准曲线下的 TRISS 预测生存率，来比较不同时间点的预测生存率。我们还根据机制和严重程度比较了早期（≤72 小时）和晚期（>72 小时）死亡。
在 1180745 例患者中，总死亡率为 6.4%，其中 59%为早期死亡，41%为晚期死亡。TRISS 对所有患者≤72 小时生存率的 AUC 为 0.919（95%CI：0.918-0.921），对>72 小时生存率的 AUC 为 0.845（95%CI：0.843-0.848）。基于钝器/穿透机制和严重程度，所有队列中早期和晚期死亡组之间的 AUC 存在显著差异。TRISS 对穿透伤的早期生存率预测良好，但在穿透伤的晚期生存率和所有钝器伤的生存率预测中可靠性较差。TRISS 倾向于低估生存率，特别是对于生存率较低的患者，晚期死亡率预测的差异更大。
TRISS 的预测能力根据死亡时间和关键损伤因素而有很大差异。TRISS 可能最适合用于预测穿透伤的早期生存率，但在预测所有类型损伤的晚期死亡率时，其可靠性和准确性会降低。
