Value of trauma and injury severity score in predicting mortality of trauma patients in different rank hospitals / 中华创伤杂志

ObjectiveTo evaluate the trauma care effect and the value of trauma and injury severity score (TRISS) in prediction of the mortality by using TRISS to calculate the survival probability of trauma patients in five hospitals from Zhejiang province in 2009.MethodsA retrospective study was done on trauma patients (study group) firstly admitted to Emergency Department of five hospitals from Zhejiang province in 2009.The relevant information was collected,including demographic data,trauma types and injury causes.The TRISS score was obtained through calculating injury severity score (ISS) and revised trauma score (RTS) on admission into emergency department.With the major trauma outcome study (MTOS) as control group,M value,standardized Ws value and 95％ confidence interval (CI) were calculated to compare actual survival rate and anticipation survival rate.ResultsA total of 2 193 patients at mean age of 44.39 years were enrolled in the study,including 1 661 male patients (75.74％).Traffic accident injury was the most common,followed by fall injury.The mortality rate according to TRISS was 13.22％,but the actual mortality rate was 9.75％.For all the patients,M =0.80 indicated that the injury severity of the study group was significantly different from that of the control group.At the same time,Ws =2.15,95％ CI for Ws:1.54-2.77 showed that the actual survival rate of the study group was significantly higher than that of the control group.Besides,the survival rate of trauma patients in the affiliated hospitals and three hospitals at class A grade was significantly higher fian that of the control group,but there was no significant difference between three hospitals at class B grade and control group. ConclusionsTRISS overestimates the mortality of the study group,which is probably associated with the rapid development of traumatology and the old coefficients of TRISS.Setting up local trauma database and renewing coefficients of TRISS may improve the ability of TRISS in predicting mortality of the trauma patients.

Analysis of Factors Influencing the Severity of Cultivator-Related Trauma patients and Correlation between these Factors

PURPOSE: Rural areas of Korea are already aged societies, and the victims of trauma in these areas are increasingly associated with an elderly demographic and farm equipment use. In addition, rural medical services are often not well supported. The purpose of this study was to evaluate the factors that influence the severity and prognosis of cultivator-related trauma, and the correlations between these factors. METHODS: We retrospectively analyzed patients who visited the Chonnam National University Hospital emergence center due to cultivator-related trauma, from January 2006 to December 2010. The injury severity of these patients was analyzed according to the injury severity score (ISS), the revised trauma score (RTS), the new injury severity score (NISS) and the trauma score and injury severity score (TRISS). RESULTS: A total of 376 cases, 322 male and 54 female, of cultivator-related trauma were reviewed. Patient ages ranged from 25 to 85 years (median, 57 years). Patients were divided into two age groups, those older than 65-years of age and those younger than 65. The primary causes of traumatic injury were falling down (57.2%), and vehicle overturning (16.5%). The site most frequently injured was the chest (35.1%). Rate of acute complication was 29.8% and operation was required in 41% of cases. The average ISS was 9.0 (median range [quartile], 4-16). ISS, NISS, RTS and TRISS were statistically correlated with the mechanism of injury, site of injury, and mortality and complication rates. In particular, TRISS was significantly lower in cultivator-related trauma for those older than 65-years of age. CONCLUSION: Among the severity indexes in assessing cultivator-related trauma, TRISS is helpful in assigning severity and predictable index in older, rural patients. However, this result is not representative of all possible cultivator-related traumas. A new statistical model is necessary to accurately analyze the severity and mortality in cases of cultivator-related trauma.

Alternative Method of Trauma Patient Evaluation and Quality Assessment

PURPOSE: The Injury Severity Score (ISS) has limited predictive power and is difficult to calculate. We used the New Injury Severity Score (NISS) and compared it to the ISS. The purpose of this study was to give a prognosis and predict the mortality for trauma patients by using the ISS and the NISS and to compare Trauma and Injury Severity Score (TRISS) method using NISS with the TRISS method using ISS. METHODS: A retrospective study of 100 trauma victims who visited the emergency room of Kyungpook National University Hospital from September 2000 to May 2001 was made using the ISS, the NISS, and the TRISS methods. RESULTS: A comparison between survivors and nonsurvivors showed differences in the revised trauma score (RTS), ISS, NISS, and TRISS Ps-1 by using RTS and the ISS and TRISS Ps-2 by using RTS and NISS (p<0.01). We found that the NISS was more predictive of survival than the ISS. A receiver operating curve analysis and Hosmer Lemeshow statistics showed that both the NISS and the ISS provided a good fit throughout its entire range of prediction. CONCLUSION: By comparing the ISS with the NISS, we concluded that the NISS better separated survivors from nonsurvivors. The NISS predicted survival better and was easier to calculate than the ISS. The results of the TRISS method using NISS were satisfactory, and we expect to use this method in quality assessment with further study and modification.