Background Trauma and Injury Severity Score (TRISS) methodology has become a standard tool for evaluating the performance of trauma centres and identifying cases for critical review.
Recent work has identified several limitations and questioned the validity of the methodology in certain types of trauma.
Methods The usefulness and limitations of the TRISS methodology were evaluated in an urban trauma centre.
Trauma registry data of 5445 patients with major trauma were analysed with respect to 30 demographic, prehospital, injury severity and hospitalization attributes.
The performance of TRISS was measured primarily by the percentage of misclassifications, including false positives and false negatives, comparing the survival status predicted by TRISS with the true status.
Sensitivity, specificity, and positive and negative predictive values were also measured for subgroups defined by the 30 attributes.
Logistic regression analysis was used to identify significant independent factors related to the performance of TRISS.
Results The overall misclassification rate was 4.3 per cent.
However, in many subgroups of patients with severe trauma the misclassification rate was very high :
34 per cent in patients older than 54 years with Injury Severity Score (ISS) greater than 20 ;
29 per cent in those with fall injuries and ISS above 20 ;
29 per cent in patients with injuries involving four or more body areas and ISS greater than 20 ;
Mots-clés Pascal : Traumatisme, Evaluation, Méthodologie, Dépistage, Critère sélection, Diagnostic, Zone urbaine, Hôpital, Organisation santé
Mots-clés Pascal anglais : Trauma, Evaluation, Methodology, Medical screening, Selection criterion, Diagnosis, Urban area, Hospital, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0162820
Code Inist : 002B16N. Création : 21/07/1998.