Lett R R, Hanley J A, Smith J S
Department of Surgery, McGill University, Montreal, Canada.
J Trauma. 1995 Jan;38(1):142-8. doi: 10.1097/00005373-199501000-00032.
The relative merits of injury severity instruments are often difficult to determine because the statistical techniques, study populations, and outcomes used in trauma research tend to obscure rather than elucidate differences in performance.
To describe the advantages of likelihood ratio and receiver operator characteristic (ROC) curve analyses and to demonstrate them using study populations and outcomes that facilitate instrument discrimination.
Previously published data on the performance of the "Injury Severity Score" and of four triage instruments in the prediction of mortality; paired comparison of two instruments in a previously unpublished trauma registry dataset; use of likelihood ratio and ROC analyses.
In a comparison of triage instruments this study clearly showed that CRAMS, PHI, and RTI, which contain nonphysiological information, have higher performance levels than the Revised Trauma Score (RTS), which is restricted to physiological information. Absolute performance gains of these instruments over the RTS ranged from 5.9% to 43.5%. This study also noted that the ISS performs equally well for blunt and penetrating trauma, and affirms concerns about the adequacy of its performance.
Likelihood ratio and ROC curve analyses demonstrate differences in injury severity instrument performance that were obscured by less rigorous methods of comparison.
损伤严重程度评估工具的相对优势往往难以确定，因为创伤研究中使用的统计技术、研究人群和结果往往掩盖而非阐明了工具性能的差异。
描述似然比和受试者工作特征（ROC）曲线分析的优势，并使用有助于工具区分的研究人群和结果进行展示。
先前发表的关于“损伤严重程度评分”和四种分诊工具预测死亡率的性能数据；在一个先前未发表的创伤登记数据集里对两种工具进行配对比较；使用似然比和ROC分析。
在分诊工具的比较中，本研究清楚地表明，包含非生理信息的CRAMS、PHI和RTI比仅限于生理信息的修订创伤评分（RTS）具有更高的性能水平。这些工具相对于RTS的绝对性能提升范围为5.9%至43.5%。本研究还指出，损伤严重程度评分（ISS）在钝性伤和穿透伤中的表现同样良好，并肯定了对其性能充分性的担忧。
似然比和ROC曲线分析揭示了损伤严重程度评估工具性能的差异，而这些差异被不太严格的比较方法所掩盖。
