Champion H R, Copes W S, Sacco W J, Frey C F, Holcroft J W, Hoyt D B, Weigelt J A
University of Maryland, National Study Center for Trauma and EMS, Baltimore 21201, USA.
J Trauma. 1996 Jan;40(1):42-8; discussion 48-9. doi: 10.1097/00005373-199601000-00009.
In 1986, data from 25,000 major trauma outcome study patients were used to relate Trauma and Injury Severity Score (TRISS) values to survival probability. The resulting norms have been widely used. Motivated by TRISS limitations, A Severity Characterization of Trauma (ASCOT) was introduced in 1990. The objective of this study was to evaluate and compare TRISS and ASCOT probability predictions using carefully collected and independently reviewed data not used in the development of those norms.
This was a prospective data collection for consecutive admissions to four level I trauma centers participating in a major trauma outcome study.
Data from 14,296 patients admitted to the four study sites between October 1987 through 1989 were used. The indices were evaluated using measures of discrimination (disparity, sensitivity, specificity, misclassification rate, and area under the receiver-operating characteristic curve) and calibration [Hosmer-Lemeshow goodness-of-fit statistic (H-L)].
For blunt-injured adults, ASCOT has higher sensitivity than TRISS (69.3 vs. 64.3) and meets the criterion for model calibration (H-L statistic < 15.5) needed for accurate z and W scores. The TRISS does not meet the calibration criterion (H-L = 30.7). For adults with penetrating injury, ASCOT has a substantially lower H-L value than TRISS (20.3 vs. 138.4), but neither meets the criterion. Areas under TRISS and ASCOT ROC curves are not significantly different and exceed 0.91 for blunt-injured adults and 0.95 for adults with penetrating injury. For pediatric patients, TRISS and ASCOT sensitivities (near 77%) and areas under receiver-operating characteristic curves (both exceed 0.96) are comparable, and both models satisfy the H-L criterion.
In this age of health care decisions influenced by outcome evaluations, ASCOT's more precise description of anatomic injury and its improved calibration with actual outcomes argue for its adoption as the standard method for outcome prediction.
1986年，25000例重大创伤结局研究患者的数据被用于将创伤和损伤严重程度评分（TRISS）值与生存概率相关联。由此得出的规范已被广泛使用。受TRISS局限性的影响，1990年引入了创伤严重程度特征化评分（ASCOT）。本研究的目的是使用在这些规范制定过程中未使用的经过仔细收集和独立审核的数据，评估和比较TRISS和ASCOT的概率预测。
这是一项对参与重大创伤结局研究的四个一级创伤中心连续入院患者进行的前瞻性数据收集。
使用了1987年10月至1989年期间在四个研究地点入院的14296例患者的数据。使用判别指标（差异、敏感性、特异性、错误分类率和受试者工作特征曲线下面积）和校准指标[Hosmer-Lemeshow拟合优度统计量（H-L）]对这些指标进行评估。
对于钝性损伤的成年人，ASCOT的敏感性高于TRISS（69.3对64.3），并且符合准确的z和W评分所需的模型校准标准（H-L统计量<15.5）。TRISS不符合校准标准（H-L = 30.7）。对于穿透性损伤的成年人，ASCOT的H-L值远低于TRISS（20.3对138.4），但两者均不符合标准。TRISS和ASCOT ROC曲线下面积无显著差异，钝性损伤成年人超过0.91，穿透性损伤成年人超过0.95。对于儿科患者，TRISS和ASCOT的敏感性（接近77%）和受试者工作特征曲线下面积（均超过0.96）相当，且两种模型均满足H-L标准。
在这个受结局评估影响的医疗保健决策时代，ASCOT对解剖损伤的更精确描述及其与实际结局的更好校准表明应采用它作为结局预测的标准方法。
