Garber B G, Hebert P C, Wells G, Yelle J D
Department of Surgery, University of Ottawa, Canada.
J Trauma. 1997 Jul;43(1):1-5; discussion 5-7. doi: 10.1097/00005373-199707000-00001.
(1) To independently validate the Trauma and Injury Severity Score-Like (TRISS-Like) model derived by Offner et al. (Revision of TRISS for intubated patients. J Trauma. 1992;32:32-35) in a population of Canadian blunt trauma victims, and (2) to compare the ability of this model to predict mortality in early and late trauma deaths.
Prospective cohort of blunt trauma cases with Injury Severity Score > 12 identified from the Ontario Trauma Registry over a 5-year period.
The TRISS-Like model consisting of age, Injury Severity Score, systolic blood pressure, and best motor response of the Glasgow Coma Scale was evaluated as to its ability to predict mortality by determining the sensitivity, specificity, and the area under the receiver operating characteristic curve. The sample was then divided into early (< or = 7 days) and late mortality subgroups in which model performance was evaluated with respect to time of death.
A total of 7,703 patients were included in this analysis. The overall mortality was 12.3%. The TRISS-Like model allowed for assessment of an additional 23% of patients than would standard TRISS and performed with a sensitivity of 97.1%, specificity of 39.8% and an area under the receiver operating characteristic curve of 0.873. Analysis of mortality with respect to time demonstrated that 75% of deaths occurred by day 7. The specificity and receiver operating characteristic area increased in the early (< or = 7 days) subgroup, 46.5% and 0.935, respectively, compared with 20.8% and 0.778 in the late mortality group.
TRISS-Like demonstrated similar performance to that reported with the standard TRISS model but with the additional advantage that it is more generalizable because it can be applied to intubated patients. TRISS-Like demonstrated substantially superior performance in early trauma deaths compared with those that occurred late. This differential performance may be because the model does not include risk factors for late mortality.
（1）在加拿大钝性创伤受害者群体中独立验证由奥夫纳等人推导的类创伤和损伤严重度评分（TRISS-Like）模型（《气管插管患者TRISS的修订。创伤杂志》。1992年；32：32 - 35），以及（2）比较该模型预测早期和晚期创伤死亡患者死亡率的能力。
从安大略创伤登记处5年期间确定的损伤严重度评分>12的钝性创伤病例前瞻性队列。
通过确定敏感性、特异性和受试者操作特征曲线下面积，评估由年龄、损伤严重度评分、收缩压和格拉斯哥昏迷量表最佳运动反应组成的TRISS-Like模型预测死亡率的能力。然后将样本分为早期（≤7天）和晚期死亡亚组，在其中根据死亡时间评估模型性能。
本分析共纳入7703例患者。总体死亡率为12.3%。与标准TRISS相比，TRISS-Like模型能够多评估23%的患者，其敏感性为97.1%，特异性为39.8%，受试者操作特征曲线下面积为0.873。按时间分析死亡率表明，75%的死亡发生在第7天。早期（≤7天）亚组的特异性和受试者操作特征曲线下面积分别增加到46.5%和0.935，而晚期死亡组分别为20.8%和0.778。
TRISS-Like表现出与标准TRISS模型报告的性能相似，但具有额外优势，即它更具通用性，因为它可应用于气管插管患者。与晚期创伤死亡相比，TRISS-Like在早期创伤死亡中表现出显著优越的性能。这种差异性能可能是因为该模型未包括晚期死亡的危险因素。
