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PURPOSE@#The injury severity score (ISS) and new injury severity score (NISS) have been widely used in trauma evaluation. However, which scoring system is better in trauma outcome prediction is still disputed. The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes, including mortality, intensive care unit (ICU) admission and ICU length of stay.@*METHODS@#The data were collected retrospectively from three hospitals in Zhejiang province, China. The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic (ROC) curves and Hosmer-Lemeshow statistics.@*RESULTS@#A total of 1825 blunt trauma patients were enrolled in our study. Finally, 1243 patients were admitted to ICU, and 215 patients died before discharge. The ISS and NISS were equivalent in predicting mortality (area under ORC curve [AUC]: 0.886 vs. 0.887, p = 0.9113). But for the patients with ISS ≥25, NISS showed better performance in predicting mortality. NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay.@*CONCLUSION@#NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS. Considering the convenience of NISS in calculation, it is advantageous to promote NISS in China's primary hospitals.
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Objective: To evaluate the ability of new injury severity score (NISS), acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), a combination of NISS and GCS, a combination of APACHE II and GCS, a combination of NISS and APACHE II to predict all-cause mortality of patients with severe trauma in mainland China. Methods: This was a multicenter observational cohort study conducted in the ICU of the Chonggang General Hospital, Daping Hospital of the Army Medical University and Affiliated Hospital of Zunyi Medical College from January 2012 to August 2016. The score of NISS, APACHE II, GCS, a combination of NISS and GCS, a combination of APACHE II and GCS, a combination of NISS and APACHE II were calculated based on data from the first 24 hours of ICU admission. Data were processed with Student's t-test, chi-square test, and receiver operating characteristic (ROC) curve of six scoring systems. Calibration was assessed with the Hosmer-Lemeshow test. The primary endpoint was death from any cause during ICU stay. Results: A total of 852 and 238 patients with severe trauma were assigned to the derivation group and validation group, respectively. Area under the ROC curve (AUC) was 0.826 [95% confidence interval (CI)=0.794-0.855)] for NISS, 0.802 (95% CI=0.768-0.832) for APACHE II, 0.808 (95% CI=0.774-0.838) for NGCS, 0.859 (95% CI=0.829 -0.886) for NISS+NGCS, 0.864 (95% CI=0.835-0.890) for APACHE II +NGCS, 0.896 (95% CI=0.869-0.929) for NISS+APACHE II in the derivation cohort. Similarly, the score of NISS+APACHE II was also better than the other five scores in the validation cohort (AUC=0.782; 95% CI=0.725-0.833) and had a good calibration (P=0.41). Conclusions: Taking into account anatomical and physiological parameters completely, the combination of NISS and APACHE II performs better than NISS, APACHE II, NGCS, NISS+NGCS, APACHE II +NGCS for predicting mortality in ICU severe trauma patients. It is needful to develop models that contain various types of accessible predictors (demographic variables, injury cause/mechanism, physiological and anatomical variables, etc.) as comprehensive as possible.
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Objective: To evaluate the ability of new injury severity score (NISS), acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), a combination of NISS and GCS, a combination of APACHE II and GCS, a combination of NISS and APACHE II to predict all-cause mortality of patients with severe trauma in mainland China. Methods: This was a multicenter observational cohort study conducted in the ICU of the Chonggang General Hospital, Daping Hospital of the Army Medical University and Affiliated Hospital of Zunyi Medical College from January 2012 to August 2016. The score of NISS, APACHE II, GCS, a combination of NISS and GCS, a combination of APACHE II and GCS, a combination of NISS and APACHE II were calculated based on data from the first 24 hours of ICU admission. Data were processed with Student's t-test, chi-square test, and receiver operating characteristic (ROC) curve of six scoring systems. Calibration was assessed with the Hosmer-Lemeshow test. The primary endpoint was death from any cause during ICU stay. Results: A total of 852 and 238 patients with severe trauma were assigned to the derivation group and validation group, respectively. Area under the ROC curve (AUC) was 0.826 [95% confidence interval (CI)=0.794-0.855)] for NISS, 0.802 (95% CI=0.768-0.832) for APACHE II, 0.808 (95% CI=0.774-0.838) for NGCS, 0.859 (95% CI=0.829 -0.886) for NISS+NGCS, 0.864 (95% CI=0.835-0.890) for APACHE II +NGCS, 0.896 (95% CI=0.869-0.929) for NISS+APACHE II in the derivation cohort. Similarly, the score of NISS+APACHE II was also better than the other five scores in the validation cohort (AUC=0.782; 95% CI=0.725-0.833) and had a good calibration (P=0.41). Conclusions: Taking into account anatomical and physiological parameters completely, the combination of NISS and APACHE II performs better than NISS, APACHE II, NGCS, NISS+NGCS, APACHE II +NGCS for predicting mortality in ICU severe trauma patients. It is needful to develop models that contain various types of accessible predictors (demographic variables, injury cause/mechanism, physiological and anatomical variables, etc.) as comprehensive as possible.
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Resumen Objetivo: estimar los determinantes de los costos de atención y rehabilitación de personas lesionadas en accidentes de tránsito en Medellín, Colombia. Materiales y métodos: estudio de seguimiento a un año de 483 pacientes atendidos por lesiones moderadas y graves. Se incluyeron costos médicos, calculados a partir de los sistemas de facturación de los hospitales, y costos indirectos, asociados a la incapacidad para pacientes y cuidadores. Los determinantes del costo total se estimaron mediante un modelo lineal generalizado. Resultados: los costos de los pacientes graves fueron en promedio USD $2152 mayores que los de pacientes con lesiones moderadas. Quienes ingresaron a unidades de cuidados intensivos y especiales generaron costos adicionales de USD $29 362 y USD $5746 con respecto a quienes no lo hicieron. Los costos indirectos ascendieron al 3 % del costo total. Conclusiones: la gravedad de la lesión y el tipo de atención fueron los que más afectaron los costos de atención y rehabilitación.
Abstract Objective: estimating the determinants of the costs of care and rehabilitation of people injured in traffic accidents in Medellin, Colombia. Materials and Methods: follow-up study for a year on 483 patients treated due to moderate and severe injuries. We included medical costs calculated based on the hospital billing systems and indirect costs associated to the incapacity for patients and caregivers. The determinants of the total cost were estimated by means of a generalized linear model. Results: the costs for severely injured patients were, on average, higher by US $2,152 than those of patients with moderate injuries. Those who were interned in the intensive and special care units generated additional costs amounting to US $29,362 and US $5,746 in comparison to those who were not interned there. Indirect costs amounted to 3% of the total cost. Conclusions: the severity of the injuries and the type of care were the factors that influenced the most the cost of care and rehabilitation.
Resumo Objetivo: estimar as determinantes de custos de atendimento e reabilitação de pessoal leso em acidentes de trânsito em Medellín, Colômbia. Materiais e métodos: estudo de acompanhamento durante um ano de 483 pacientes atendidos por lesões moderadas e críticas. Incluíram-se custos médicos, calculados a partir dos sistemas de faturação dos hospitais e custos indiretos, associados à incapacidade para pacientes e cuidadores. As determinantes do custo total foram estimadas mediante modelo lineal generalizado. Resultados: os custos dos pacientes críticos foram USD $2152 em media, superiores aos de pacientes com lesões moderadas. Aqueles que ingressaram a unidades de tratamento intensivo e especial geraram custos adicionais de USD $29 362 e USD $5746 no que diz respeito de aqueles que não. Os custos indiretos ascenderam a 3% do custo total. Conclusões: a gravidade da lesão e o tipo de atendimento foram os que mais afetaram os custos de atendimento e reabilitação.
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OBJECTIVE: To investigate the clinical characteristics of patients involved in road traffic accidents according to the New Injury Severity Score (NISS). METHODS: In this study, medical records of 1,048 patients admitted at three hospitals located in different regions between January and December 2014 were retrospectively reviewed. Only patients who received inpatient treatments covered by automobile insurance during the period were included. Accidents were classified as pedestrian, driver, passenger, motorcycle, or bicycle; and the severity of injury was assessed by the NISS. RESULTS: The proportion of pedestrian traffic accident (TA) was the highest, followed by driver, passenger, motorcycle and bicycle TA. The mean NISS was significantly higher in pedestrian and motorcycle TAs and lower in passenger TA. Analysis of differences in mean hospital length of stay (HLS) according to NISS injury severity revealed 4.97±4.86 days in the minor injury group, 8.91±5.93 days in the moderate injury group, 15.46±11.16 days in the serious injury group, 24.73±17.03 days in the severe injury group, and 30.86±34.03 days in the critical injury group (p<0.05). CONCLUSION: The study results indicated that higher NISS correlated to longer HLS, fewer home discharges, and increasing mortality. Specialized hospitals for TA patient rehabilitation are necessary to reduce disabilities in TA patients.
Subject(s)
Humans , Accidents, Traffic , Automobiles , Injury Severity Score , Inpatients , Insurance , Length of Stay , Medical Records , Mortality , Motorcycles , Rehabilitation , Retrospective StudiesABSTRACT
Introduction: Traffic accidents (TA) cause 1.23 million deaths each year worldwide while between 20 and 50 million persons are injured each year. In 2011 in Medellin, Colombia, there were 307 traffic deaths and 23,835 injured with 411 accidents for each 10,000 vehicles. Objective: The purpose of the study was to describe the epidemiologic and clinical characteristics, as well as the quality of life and disability outcomes for those injured in traffic accidents in Medellin. Methods: This prospective, descriptive, cross-sectional study collected data from 834 patients that were classified with the New Injury Severity Score (NISS) , the WHO-DAS-II (Disability Assessment) Scale and the SF-36 Health Survey. Results: Three-fourths (75.8%) of the patients were male. Eighty-one percent (81.0%) of patients were involved in motorcycle accidents, with 45.6% suffering moderate trauma, and 32.6% experiencing severe trauma. Of the patients with severe trauma, 8.5% were not wearing helmets. Half of the sample (49.7%) injured their extremities. The WHODAS-II domains most affected were: Activities outside the home (62.0%), Housework (54.3%) and Moving in one's environment (45.2%). Quality of life areas affected were: Physical role (20.3%), Body pain (37.3%), Emotional role (44.1%), Physical functioning (52.6%). Conclusions: Patients with more severe injuries had higher levels of disability and a worse quality of life. Motorcycles made up a large proportion of traffic accidents in this city and mitigation strategies to reduce this public health problem should particularly focus on this high-risk group.
Antecedentes: Los accidentes de tránsito (AT) causan 1.23 millones de muertes en el mundo, y entre 20 y 50 millones sufren lesiones no fatales. En Medellín (Colombia) en el 2011 hubo 307 muertos en AT y 23.835 heridos, con 411 accidentes por cada 10.000 vehículos. Objetivo: Describir las características epidemiológicas, clínicas, de calidad de vida y discapacidad de los pacientes luego de un AT en Medellín. Métodos: Estudio descriptivo trasversal prospectivo del estado inicial de una cohorte de 834 pacientes, clasificados de acuerdo a la gravedad de trauma (NISS) y las escalas WHO-DAS II y SF-36. Resultados: En el 81% de los AT estuvieron involucradas motos, con lesiones moderadas en el 45.6 %, y graves en el 32.6% de ellos. No utilizaban casco el 8.5% de los pacientes con NISS grave. En el 49.7% se afectaron los miembros inferiores. Los dominios del WHO-DAS II más afectados fueron: actividades fuera del hogar (62.0%) actividades domésticas (54.3%) y moverse en el entorno (45.2%). La calidad de vida comprometió los dominios de desempeño físico (20.3%), dolor corporal (37.3%), desempeño emocional (44.1%) y funcionamiento físico (52.6%). Conclusiones: Los pacientes con lesiones más graves tuvieron mayor compromiso en la discapacidad y en la calidad de vida. Esta carga de enfermedad la producen principalmente los AT en los que están involucradas las motos.
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Medidas de gravidade de trauma são instrumentos importantes para estimar prognóstico. Recentemente, o "Injury Severity Score" (ISS), consagrado, nas últimas décadas, como medida de gravidade de trauma de base anatômica, foi modificado pelos seus próprios precursores a fim de sanar algumas deficiências que diminuíam seu poder preditivo em vítimas com várias lesões em uma única região corpórea. Denominaram esse novo índice de "New Injury Severity Score" (NISS). Os estudos publicados têm apresentado o NISS como melhor preditor de morbi-mortalidade, que o ISS, a curto prazo. O presente estudo tem como objetivo comparar os resultados obtidos pelo ISS e o NISS e apresentar qual dos dois índices melhor se relacionam com as conseqüências a médio e longo prazos em vítimas de trauma crânio-encefálico (TCE). Para avaliar essas conseqüências foi utilizada a Escala de Resultados de Glasgow original (ERG) e a Escala de Resultados de Glasgow Ampliada (ERGa). A amostra foi constituída de 63 vítimas de TCE contuso, de 12 a 65 anos, acompanhadas no ambulatório do trauma do Hospital sas Clínicas da FAculdade de Medicina da Universidade de São Paulo, admitidas até 72 horas após trauma. A média dos valores NISS foi significativamente maior quando comparada ao ISS. Em 42 casos, o NISS apresentou posições diferentes e mais elevadas em relações ao ISS, quando analisados por intervalos de gravidade. Quanto à efetividade de predizer conseqüências nas vítimas de TCE, os dois índices apresentaram semelhante performance tanto na análise da correlação entre ISS, NISS e ERG e ERGa, como também na análise da capacidade de separar vítimas dependentes e independentes pós-trauma.
Trauma severity scores are important tools for predicting prognosis. Recently, Injurity Severity Score (ISS), considered the standard summary measure of anatomic injury in the last decades, was changed by its own authors in order to eliminate some deficiencies that could decrease its predictive power in patients with several lesions in only one body region. The new score was called New Injury Severity Score (NISS). Published studies have presented NISS as better short-term morbid-mortality predictor than ISS. This study aims to compare results obtained by ISS and NISS, and to indicate which of the two scores has the best relation with medium and long term outcome in traumatic brain injury (TBI) patients. In order to evaluate this outcome, the original Glasgow Outcome Scale (GOS) and the Extended Glasgow Outcome Scale (GOSE) were used. The sample was made up of 63 blunt TBI patients, aged from 12 to 65, fallow up in the Trauma Canter of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, admitted in up to 72 hours after the trauma. The number average was significantly higher in NISS, when it was compared to ISS. In 42 cases, NISS presented different and more elevated positions than ISS, when they were analyzed through severity intervals. concerning effectiveness when predicting outcome in TBI patients, both scores presented a similar performance, when analyizing the relation between ISS, NISS and GOS and GOSE, and also when analyizing the capacity to separate post-trauma dependent and independent patients.
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Nursing Research , Injury Severity Score , Craniocerebral Trauma , PrognosisABSTRACT
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.
Subject(s)
Humans , Emergency Service, Hospital , Injury Severity Score , Mortality , Prognosis , Retrospective Studies , SurvivorsABSTRACT
PURPOSE: The Injury Severity Score (ISS), which is defined as the sum of the squares of the single highest Abbreviated Injury Scale (AIS) score in each of the three most severely injured body regions, does not take into account multiple injuries in the same body region. The New ISS (NISS), which is defined as the sum of the squares of the AIS scores of a patient's three most severe injuries regardless of body region, has been proposed to provide a more accurate measure of trauma severity. The purpose of this study was to evaluate the ISS and the NISS in patients with chest trauma. METHODS: A retrospective study of 263 cases of trauma victims with chest injuries, who visited the emergency center of Daegu Catholic University Hospital during a 42-month-period from January 1998 to June 2001, was performed. For each patient, we calculated the ISS and the NISS. The power of the two scoring systems to predict hospital length of stay, intensive care, operation, and mortality was gauged through comparison of receiver operating characteristic (ROC) curves. RESULTS: The mean ISS was 12, and the mean NISS was 14. The areas under the curves (AUC) of the hospital length of stay (0.764 vs 0.762), operation (0.772 vs 0.764), and mortality (0.873 vs 0.860) were greater for the ISS than the NISS. CONCLUSION: The significant difference in the predictive abilities of the ISS and the NISS reported in studies of severe blunt trauma patients was not seen in this review of moderate trauma patients with chest injuries.