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Med Intensiva. 2016 Oct;40(7):395-402. doi: 10.1016/j.medin.2015.11.003. Epub 2016 Apr 8.

Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI).

[Article in English, Spanish]

Author information

1
Trauma and Emergencies ICU, Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain.
2
Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain. Electronic address: juanantonio.llompart@ssib.es.
3
Department of Intensive Care Medicine, Hospital Virgen de la Salud, Toledo, Spain.
4
Department of Intensive Care Medicine, Hospital Universitario de Donostia, San Sebastián, Spain.
5
Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain.
6
Department of Intensive Care Medicine, Complejo Hospitalario de Torrecárdenas, Almería, Spain.
7
Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
8
Department of Intensive Care Medicine, Hospital Universitario Carlos Haya, Málaga, Spain.
9
Department of Intensive Care Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
10
Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
11
Department of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
12
Department of Intensive Care Medicine, Complejo Hospitalario de Pamplona, Navarra, Spain.
13
Department of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
14
Department of Intensive Care Medicine, Hospital Universitario de Getafe, Madrid, Spain.
15
Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.

Abstract

OBJECTIVES:

To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI).

DESIGN:

A prospective, multicenter registry evaluation was carried out.

SETTING:

Thirteen Spanish Intensive Care Units (ICUs).

PATIENTS:

Individuals with traumatic disease and available data admitted to the participating ICUs.

INTERVENTIONS:

Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant.

MAIN VARIABLES OF INTEREST:

Predicted and observed mortality.

RESULTS:

A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality.

CONCLUSIONS:

TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.

KEYWORDS:

Intensive Care Unit; Mortality prediction; Predicción de mortalidad; Registros de trauma; TRISS; Trauma; Trauma registry; Unidad de Cuidados Intensivos

PMID:
27068001
DOI:
10.1016/j.medin.2015.11.003
[Indexed for MEDLINE]
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