Comparison of the new injury severity score and the injury severity score in multiple trauma patients

ZHAO Xiao-gang; MA Yue-feng; ZHANG Mao; GAN Jian-xin; XU Shao-wen; JIANG Guan-yu

摘要

Objective: To assess whether these characteristics of less misclassification and greater area under receiver opera-tor characteristic (ROC) curve of the new injury severity score (NISS) are better than the injury severity score (ISS) as applying it to our multiple trauma patients registered into the emergency intensive care unit (EICU). Methods: This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively reg-istered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and mul-tivariate logistic progression model. Results: Among the 2 286 patients, 176 (7.7%) were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 110 patients. Mean EICU length of stay (LOS) was 7.8 days±2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and headeck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the pen-etrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups (4.01% versus 4.49%). However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate (21.04% versus 15.55% for ISS, t=-3.310, P<0.001), resulting in an over-all misclassification rate of 23.57% for NISS versus 18.79% for ISS (t=3.290, P<0.001). In the whole sample, NISS pre-sented equivalent discrimination (area under ROC curve:NISS=0.938 versus ISS=0.943). The H-L statistics showed poorer calibration (48.64 versus 32.11, t=3.305, P<0.001) in the penetrating injury group. Conclusions: NISS should not replace ISS because they share similar accuracy and calibration in predicting multiple blunt trauma patients. NISS may be more sensitive but less specific than ISS in predicting mortality in certain penetrating injury patients.

机译：目的：评估将新错误严重程度评分（NISS）的接收者操作者特征（ROC）曲线下的分类错误少和面积大的这些特征是否优于将其应用于我们的多发性创伤患者的伤害严重程度得分（ISS）已注册到紧急重症监护病房（EICU）。方法：这是对1997年1月1日至2006年12月31日在中国浙江大学医学院附属第二医院连续入选EICU的2 286名多发性创伤患者的登记数据的回顾性回顾。 ISS和NISS之间的比较是使用错误分类率，ROC曲线分析以及通过单变量和多变量Logistic进步模型进行的H-L统计进行的。结果：在2 286例患者中，有176例（7.7％）因到达时死亡或16岁以下患者而被排除在外。因此，研究人群包括2 110名患者。 EICU平均住院天数（LOS）为7.8天±2.4天。与钝性损伤组相比，穿透性损伤组的男性百分比更高，平均EICU LOS和年龄更低。受伤最严重的身体部位是四肢和头/颈，其次是胸部，面部和腹部。而在穿透笔眼的损伤组中，胸部和腹部更为常见。所有组中NISS的最小错误分类率均略低于ISS（4.01％对4.49％）。但是，NISS在穿透性损伤组中有更多的错误分类倾向。我们注意到，这主要归因于较高的假阳性率（21.04％比ISS的15.55％，t = -3.310，P <0.001），导致NISS的总体错误分类率为23.57％，而总体误分类率为18.79％。对于ISS（t ＝ 3.290，P ＜0.001）。在整个样本中，NISS表示等效的区分（ROC曲线下的区域：NISS = 0.938对ISS = 0.943）。 H-L统计数据表明，穿透性损伤组的校正较差（48.64比32.11，t = 3.305，P <0.001）。结论：NISS不应取代ISS，因为它们在预测多发性钝伤患者中具有相似的准确性和校准。在预测某些穿透伤患者的死亡率时，NIS比ISS更敏感，但特异性较低。

Comparison of the new injury severity score and the injury severity score in multiple trauma patients

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