Garber B G, Hebert P C, Wells G, Yelle J D
Department of Surgery, University of Ottawa, Canada.
J Trauma. 1996 May;40(5):733-7. doi: 10.1097/00005373-199605000-00008.
To compare outcomes in blunt trauma by using Trauma and Injury Severity Score (TRISS) models derived from the Major Trauma Outcome Study (MTOS) and the Ontario Trauma Registry (OTR) as well as to evaluate the role of the Revised Trauma Score within the TRISS model.
Consecutive blunt trauma cases from 11 Level I trauma centers over a 4-year period were identified from the OTR. Coefficients of the Revised Trauma Score were modified using the Ontario data and this score was tested by using the Hosmer-Lemeshow Goodness of Fit Test. Two Ontario-specific TRISS models were developed with revised coefficients. The first used the standard Revised Trauma Score and the second used the Revised Trauma Score with regenerated coefficients. The accuracy of mortality predictions for all models were compared by using a Hosmer-Lemeshow Goodness of Fit procedure. Additionally, each TRISS models performance characteristics and receiver operating characteristic (ROC) curves were used to evaluate their discriminative capabilities.
A total of 5,436 cases were incorporated in the analysis. Patients with all component TRISS variables had a significantly lower mortality compared to all blunt trauma patients (7.0% vs. 15.5%,p < 0.01). Use of the Revised Trauma Score led to the exclusion of 40% of cases because of absent data necessary to compute the score. The Hosmer-Lemeshow Goodness of Fit statistic for the Revised Trauma Score was 79.45 (p = 0.0001). The Hosmer-Lemeshow Goodness of Fit Statistic ranged from 11.42, p = 0.175 and 13.1, p = 0.125 for the Ontario TRISS models compared to 25.62, p < 0.005 for the MTOS TRISS model. Sensitivity of all three TRISS models ranged from 98% to 99% with specificity ranging from 24% to 35%. ROC curves were identical for all three TRISS models.
TRISS demonstrated satisfactory performance in a Canadian blunt trauma population. Although revision of coefficients led to a better fit on the Hosmer-Lemeshow statistic, ROC curves demonstrated virtually identical performance of the MTOS and Ontario-based TRISS models. The poor performance of the Revised Trauma Score and the observation that its use led to the exclusion of 40% of cases with a higher mortality raises concerns regarding its use in the TRISS model.
比较使用源自重大创伤结局研究（MTOS）和安大略创伤登记处（OTR）的创伤和损伤严重程度评分（TRISS）模型在钝性创伤中的结果，并评估修订创伤评分在TRISS模型中的作用。
从OTR中识别出11个一级创伤中心在4年期间的连续钝性创伤病例。使用安大略的数据修改修订创伤评分的系数，并使用Hosmer-Lemeshow拟合优度检验对该评分进行测试。开发了两个具有修订系数的安大略特定TRISS模型。第一个使用标准修订创伤评分，第二个使用具有重新生成系数的修订创伤评分。通过使用Hosmer-Lemeshow拟合优度程序比较所有模型的死亡率预测准确性。此外，每个TRISS模型的性能特征和受试者工作特征（ROC）曲线用于评估其判别能力。
总共5436例病例纳入分析。所有TRISS变量组成部分的患者与所有钝性创伤患者相比死亡率显著更低（7.0%对15.5%，p<0.01）。修订创伤评分的使用导致40%的病例因缺乏计算该评分所需的数据而被排除。修订创伤评分的Hosmer-Lemeshow拟合优度统计量为79.45（p = 0.0001）。安大略TRISS模型的Hosmer-Lemeshow拟合优度统计量范围为11.42，p = 0.175至13.1，p = 0.125，而MTOS TRISS模型为25.62，p<0.005。所有三个TRISS模型的敏感性范围为98%至99%，特异性范围为24%至35%。所有三个TRISS模型的ROC曲线相同。
TRISS在加拿大钝性创伤人群中表现出令人满意的性能。尽管系数修订导致Hosmer-Lemeshow统计量拟合更好，但ROC曲线显示MTOS和基于安大略的TRISS模型的性能几乎相同。修订创伤评分的性能不佳以及其使用导致40%死亡率较高的病例被排除这一观察结果引发了对其在TRISS模型中使用的担忧。
