Jin He, Zhang Yuanyuan, Zhang Qi, Ouyang Lijuan, Li Xueyao, Zhang Yiyan, Yang Baosheng, Sun Junfeng, Wei Chaohui, Yang Guimei, Guan Li, Luo Shilan, Zhu Junyu, Liang Huaping
Department of Cardiothoracic Surgery 926th Hospital of Joint Logistics Support Force of PLA, Kaiyuan 661600, Yunnan, China.
Department of Wound Infection and Drug Daping Hospital Army Medical University State Key Laboratory of Trauma and Chemical Poisoning, Chongqing 400042, China.
Emerg Med Int. 2024 Aug 23;2024:4861308. doi: 10.1155/2024/4861308. eCollection 2024.
To explore the value of the injury severity score (ISS) and the new injury severity score (NISS) for evaluating injuries and predicting complications (pneumonia and respiratory failure) and poor prognoses (in-hospital tracheal intubation, extended length of hospital stay, ICU admission, prolonged ICU stay, and death) in patients with thoracic trauma.
The data of consecutive patients with thoracic trauma who were admitted to the department of cardiothoracic surgery of a tertiary hospital between January 2018 and December 2021 were retrospectively collected. ISS and NISS were calculated for each patient. The study outcomes were complications and poor prognoses. The differences in ISS and NISS between patients with complications and poor prognoses and patients without the abovementioned conditions were compared using the Mann‒Whitney test. Discrimination and calibration of ISS and NISS in predicting outcomes were compared using the area under the receiver operating characteristic (ROC) curve (AUC) and Hosmer‒Lemeshow (H-L) statistic.
A total of 310 patients were included. ISS and NISS of patients with complications and poor prognoses were greater than those of patients without complications and poor prognoses, respectively. The discrimination of ISS in predicting pneumonia, respiratory failure, in-hospital tracheal intubation, extended length of hospital stay, ICU admission, prolonged ICU stay, and death (AUCs: 0.609, 0.721, 0.848, 0.784, 0.763, 0.716, and 0.804, respectively) was not statistically significantly different from that of NISS in predicting the corresponding outcomes (AUCs: 0.628, 0.712, 0.795, 0.767, 0.750, 0.750, and 0.818, respectively). ISS showed better calibration than NISS for predicting pneumonia, respiratory failure, in-hospital tracheal intubation, extended length of hospital stay, and ICU admission but worse calibration for predicting prolonged ICU stay and death.
ISS and NISS are both suitable for injury evaluation. There was no statistically significant difference in discrimination between ISS and NISS, but they had different calibrations when predicting different outcomes.
探讨损伤严重程度评分（ISS）和新损伤严重程度评分（NISS）在评估胸部创伤患者损伤情况、预测并发症（肺炎和呼吸衰竭）及不良预后（院内气管插管、延长住院时间、入住重症监护病房、延长重症监护病房住院时间和死亡）方面的价值。
回顾性收集2018年1月至2021年12月期间在某三级医院心胸外科住院的连续性胸部创伤患者的数据。计算每名患者的ISS和NISS。研究结局为并发症和不良预后。采用Mann-Whitney检验比较有并发症和不良预后患者与无上述情况患者的ISS和NISS差异。使用受试者操作特征（ROC）曲线下面积（AUC）和Hosmer-Lemeshow（H-L）统计量比较ISS和NISS在预测结局方面的区分度和校准度。
共纳入310例患者。有并发症和不良预后患者的ISS和NISS分别高于无并发症和不良预后患者。ISS在预测肺炎、呼吸衰竭、院内气管插管、延长住院时间、入住重症监护病房、延长重症监护病房住院时间和死亡方面的区分度（AUC分别为0.609、0.721、0.848、0.784、0.763、0.716和0.804）与NISS在预测相应结局方面的区分度（AUC分别为0.628、0.712、0.795、0.767、0.750、0.750和0.818）差异无统计学意义。在预测肺炎、呼吸衰竭、院内气管插管、延长住院时间和入住重症监护病房方面，ISS的校准度优于NISS，但在预测延长重症监护病房住院时间和死亡方面，ISS的校准度较差。
ISS和NISS均适用于损伤评估。ISS和NISS在区分度方面差异无统计学意义，但在预测不同结局时校准度不同。
