Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration. The Journal of trauma. [J Trauma] Journal article | | Title | Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration. | | Author(s) | Frankema SP, Steyerberg EW, Edwards MJ, van Vugt AB | | Institution | Department of Anesthesiology, Erasmus MC Rotterdam, The Netherlands. s.frankema@erasmusmc.nl | | Source | J Trauma 2005 Mar; 58(3):596-604. | | MeSH | Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Calibration
Comparative Study
Discriminant Analysis
Female
Hospitals, Teaching
Hospitals, Urban
Humans
Injury Severity Score
Logistic Models
Male
Middle Aged
Netherlands
Predictive Value of Tests
ROC Curve
Reference Values
Registries
Survival Analysis
Survival Rate
Trauma Centers
Trauma Severity Indices
Wounds and Injuries
| | Abstract | BACKGROUND: Prediction of survival chances for trauma patients is a basic requirement for evaluation of trauma care. The current methods are the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). Scales for scoring injury severity are part of these methods. This study compared three injury scales, the Injury Severity Score (ISS), the New ISS (NISS), and the Anatomic Profile (AP), in three otherwise identical predictive models.
METHODS: Records of the Rotterdam Trauma Center were analyzed using logistic regression. The variables used in the models were age (as a linear variable), the corrected Revised Trauma Score (RTS), a denominator for blunt or penetrating trauma, and one of the three injury scales. The original TRISS and ASCOT models also were evaluated. The resulting models were compared in terms of their discriminative power, as indicated by the receiver-operator characteristic (ROC), and calibration (Hosmer-Lemeshow [HL]) for the entire range of injury severity.
RESULTS: For this study, 1,102 patients, with an average ISS of 15, met the inclusion criteria. The TRISS and ASCOT models, using original coefficients, showed excellent discriminative power (ROC, 0.94 and 0.96, respectively), but insufficient fits (HL, p = 0.001 and p = 0.03, respectively). The three fitted models also had excellent discriminative abilities (ROC, 0.95, 0.97, and 0.96, respectively). The custom ISS model was unable to fit the entire range of survival chances sufficiently (p = 0.01). Models using the NISS and AP scales provided adequate fits to the actual survival chances of the population (HL, 0.32 and 0.12, respectively).
CONCLUSIONS: The AP and NISS scores particularly both managed to outperform the ISS score in correctly predicting survival chances among a Dutch trauma population. Trauma registries stratifying injuries by the ISS score should evaluate the use of the NISS and AP scores. | | Language | eng | | Pub Type(s) | Evaluation Studies
Journal Article
| | PubMed ID | 15761357 |
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