Trauma outcome analysis and the development of regional norms

Lane, Peter L.; Doig, Gordon S.; Stewart, Tanya Charyk; Mikrogianakis, Angelo; Stefanits, T

doi:10.1016/s0001-4575(96)00061-9

Cited by 18 publications

(9 citation statements)

References 12 publications

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“…In addition, resources like assigning score one to MRV for intubated patients or considering scene values have not improved TRISS performance (36) . In the literature, several studies included variables GCS or BMR, SBP, RR and SpO 2 in the models and excluded RTS from the regression equation, as these parameters exclude more serious patients from the analyses of survival probability (intubated patients) (14,(47)(48). In the analyses of comparisons between the original TRISS and modified models, improved performance of TRISS was obtained when the RTS was removed from the model and replaced with parameters GCS, BMR, SBP and RR in the equation; however, in several studies, such replacement did not increase the predictive ability of TRISS; this predictive ability remained equivalent to the original TRISS or became worse.…”

Section: Discussionmentioning

confidence: 99%

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

Domingues¹,

Nogueira

Settervall

et al. 2015

Rev. esc. enferm. USP

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RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

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Section: Discussionmentioning

confidence: 99%

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

Domingues¹,

Nogueira

Settervall

et al. 2015

Rev. esc. enferm. USP

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“…Unfortunately, as was subsequently pointed out by its developers, TRISS had only mediocre predictive power and was poorly calibrated. Worse still, the performance of TRISS varied greatly when it was used to evaluate trauma care in other centers and countries [32,33], suggesting that either the standard of trauma care varied greatly, or, more likely, that the predictive power of TRISS was greatly affected by parameters not included in the model (‘patient mix’). Thus as a tool for comparing trauma care at different centers, TRISS, and indeed any single predictive equation, seemed fatally flawed.…”

Section: Measuring Physiological Reservementioning

confidence: 99%

Injury Severity Scoring

Osler¹,

Nelson²,

Bedrick³

1999

J Intensive Care Med

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The wish to predict outcome following injury is as old as human history, but the actual measurement of injury severity began only 40 years ago. Tools are now available to measure both physical injury [the Injury Severity Score (ISS)] and physiologic derangement [the Revised Trauma Score (RTS)], as well as their synergistic combination, into a probability of survival score (TRISS). Although these tools are in daily use in most trauma centers, their predictive power is only mediocre. While adequate for estimation of the trauma severity in populations of patients, these measures have proven inadequate for predicting individual outcomes, and their usefulness in comparing trauma systems and centers has proven problematic. Better alternatives to these tools have been developed, but adoption has been slow because these incremental improvements in predictive power have not been sufficient to allow expanded uses for injury scoring. We now face the possibility that injury scoring can never be robust enough to be either clinically useful or the basis for meaningful comparisons between trauma centers. We should continue our quest for improved outcome prediction, but we must resist demands that injury scoring systems be extended into realms where they may detract from intelligent discourse or damage clinical practice.

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“…Imagine two patients with identical injuries: four contiguous comminuted rib fractures with underlying pulmonary contusions. Worse still, the performance of TRISS varied greatly when it was used to evaluate trauma care in other centers and countries [32,33], suggesting that either the standard of trauma care varied greatly, or, more likely, that the predictive power of TRISS was greatly affected by parameters not included in the model ('patient mix'). While the latter patient is not certain to die, his situation is certainly more precarious than the healthy triathelete.…”

Section: Measuring Physiological Reservementioning

confidence: 99%