创伤严重程度评分对不同等级医院创伤患者死亡率的预测价值  

Value of trauma and injury severity score in predicting mortality of trauma patients in different rank hospitals

作　　者：李辉[1] 沈伟锋[1] 马岳峰[1] 陈卫强[3] 何小军[2] 伍峻松[1] 易建华[1] 

机构地区：[1]浙江大学医学院附属第二医院急诊中心,杭州310009 [2]《中华急诊医学杂志》编辑部 [3]杭州市卫生局

出　　处：《中华创伤杂志》2012年第5期444-448,共5页Chinese Journal of Trauma

基　　金：卫生部科学研究基金资助项目（WKJ2007-2-013）

摘　　要：目的通过创伤严重程度评分（traumaandinjuryseverityscore，TRISS）计算创伤患者的生存概率，评价创伤救治效果以及TRISS评分对死亡率的预测价值。方法回顾性分析浙江省5所医院2009年急诊科首诊的创伤患者（研究组）。收集人口统计学资料、创伤类型、致伤原因等信息，并通过计算患者进入急诊室时的ISS评分、修正创伤评分（revisedtraumascore，RTS）评分得到TRISS评分。以严重创伤结局研究（majortraumaoutcomestudy，MTOS）为对照组，通过计算M值、Ws值以及其95％可信区间（cI）比较实际生存率和期望生存率。结果共纳入2193例创伤患者，平均年龄44．39岁，其中男1661例（75．74％）。最常见的致伤原因为交通伤，其次为高处坠落伤。TRISS预测死亡率为13．22％，实际死亡率为9．75％。对于总体患者，M=0．80，提示与对照组伤情差异显著。Ws=2．15，95％CI（Ws）：1．54～2．77，说明本组生存率显著高于对照组。附属医院和三甲医院的创伤患者生存率均显著高于对照组，而三乙医院与对照组间差异无统计学意义。结论TRISS高估了本次研究中创伤群体的死亡率，这可能与近年来创伤医学的发展以及TRISS系数较为陈旧有关。建立本地的创伤数据库，更新TRISS系数有助于提高TRISS对死亡率的预测能力。Objective To 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. Methods A 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. Results A 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 than that of the control group, but there was no significant difference between three hospitals at class B grade and control group. Conclusions TRISS 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 TRIS

关 键 词：创伤和损伤 研究设计 死亡率 TRISS评分 

分 类 号：R641[医药卫生—外科学]