Demetriades D, Chan L S, Velmahos G, Berne T V, Cornwell E E, Belzberg H, Asensio J A, Murray J, Berne J, Shoemaker W
Department of Surgery, HCC, University of Southern California, Los Angeles 90033, USA.
Br J Surg. 1998 Mar;85(3):379-84. doi: 10.1046/j.1365-2168.1998.00610.x.
Trauma and Injury Severity Score (TRISS) methodology has become a standard tool for evaluating the performance of trauma centres and identifying cases for critical review. Recent work has identified several limitations and questioned the validity of the methodology in certain types of trauma.
The usefulness and limitations of the TRISS methodology were evaluated in an urban trauma centre. Trauma registry data of 5445 patients with major trauma were analysed with respect to 30 demographic, prehospital, injury severity and hospitalization attributes. The performance of TRISS was measured primarily by the percentage of misclassifications, including false positives and false negatives, comparing the survival status predicted by TRISS with the true status. Sensitivity, specificity, and positive and negative predictive values were also measured for subgroups defined by the 30 attributes. Logistic regression analysis was used to identify significant independent factors related to the performance of TRISS.
The overall misclassification rate was 4.3 per cent. However, in many subgroups of patients with severe trauma the misclassification rate was very high: 34 per cent in patients older than 54 years with Injury Severity Score (ISS) greater than 20; 29 per cent in those with fall injuries and ISS above 20; 29 per cent in patients with injuries involving four or more body areas and ISS greater than 20; 28.6 per cent in patients with injuries needing admission to the intensive care unit (ICU) and ISS greater than 20; 26.4 per cent in patients in severe distress before reaching hospital with ISS greater than 20; and 26.1 per cent in patients whose ISS score was above 20 and who had complications in hospital.
The TRISS methodology has major limitations in many subgroups of patients, especially in severe trauma. In its present form TRISS has no useful role in major urban trauma centres. Its use should be seriously reconsidered, if not abandoned.
创伤和损伤严重程度评分（TRISS）方法已成为评估创伤中心绩效和确定需要严格审查病例的标准工具。最近的研究发现了该方法的一些局限性，并对其在某些类型创伤中的有效性提出了质疑。
在一家城市创伤中心评估了TRISS方法的实用性和局限性。分析了5445例严重创伤患者的创伤登记数据，涉及30个人口统计学、院前、损伤严重程度和住院属性。TRISS的性能主要通过错误分类的百分比来衡量，包括假阳性和假阴性，将TRISS预测的生存状态与实际状态进行比较。还对由30个属性定义的亚组测量了敏感性、特异性以及阳性和阴性预测值。使用逻辑回归分析来确定与TRISS性能相关的显著独立因素。
总体错误分类率为4.3%。然而，在许多严重创伤患者亚组中，错误分类率非常高：54岁以上且损伤严重程度评分（ISS）大于20的患者中为34%；跌倒损伤且ISS高于20的患者中为29%；涉及四个或更多身体部位且ISS大于20的患者中为29%；需要入住重症监护病房（ICU）且ISS大于20的患者中为28.6%；入院前处于严重困境且ISS大于20的患者中为26.4%；ISS评分高于20且住院期间出现并发症的患者中为26.1%。
TRISS方法在许多患者亚组中存在重大局限性，尤其是在严重创伤中。以其目前的形式，TRISS在大型城市创伤中心没有有用的作用。如果不放弃，也应认真重新考虑其使用。
