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For: Sainz Cabrejas J, García Fuentes C, García Juarranz C, González López A, Maure Blesa L, Montejo González J, Chico Fernández M. Valoración de la calidad asistencial al traumatismo grave mediante comparación con estándares internacionales. Med Intensiva 2020;44:325-332. [DOI: 10.1016/j.medin.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 12/23/2022]

For:	Sainz Cabrejas J, García Fuentes C, García Juarranz C, González López A, Maure Blesa L, Montejo González J, Chico Fernández M. Valoración de la calidad asistencial al traumatismo grave mediante comparación con estándares internacionales. Med Intensiva 2020;44:325-332. [DOI: 10.1016/j.medin.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 12/23/2022]

Number	Cited by Other Article(s)
1	Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population. J Trauma Nurs 2022;29:34-40. [PMID: 35007249 DOI: 10.1097/jtn.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Abstract BACKGROUND Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned. OBJECTIVE The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population. METHODS This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics. RESULTS A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113). CONCLUSION In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking. Collapse Key Words Collapse MESH Headings Collapse Grants Collapse Affiliation(s) Collapse

Number

Cited by Other Article(s)

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population. J Trauma Nurs 2022;29:34-40. [PMID: 35007249 DOI: 10.1097/jtn.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Abstract

BACKGROUND

Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned.

OBJECTIVE

The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population.

METHODS

This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics.

RESULTS

A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113).

CONCLUSION

In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.

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