One year's experience of major trauma outcome study methodology.

Abstract

Outcome measures-Review of case notes with TRISS (trauma score, injury severity score) methodology to compare expected and observed survival.Results-Most (421/678) admissions were due to single orthopaedic injury. Serious injury was uncommon with only 43 patients having injury severity scores >15. The calculated probability of survival matched the observed outcome for most of the seriously injured patients, with only two unexpected deaths. However, 36 of the 61 deaths in the 678 patients occurred in elderly patients with a fractured neck of the femur, and all of these patients had a high probability of survival predicted by TRISS methodology.

Trauma survival prediction in Asian population: a modification of TRISS to improve accuracy

“…TRISS has been a widely used method in day-to-day trauma management, auditing, as well as research 15 23–27. Its validity has been proven by publications worldwide following its introduction in the 1990s 24 28–32.…”

“…As traumatology is evolving into a geriatric discipline, and more reports have indicated that hospitalisation rates for trauma increases with age,9–11 age has represented an independent predictor of survival in the trauma population 12 13. In addition, external validation of MTOS P S on a population with very different population characteristics provides evidence that data-derived P S are robust to case-mix variation, which has been proven by studies in the UK and Canada 14 15. It is possible that age misclassification may have led to an underestimation of injury severity in these patients 16.…”

Registry based trauma outcome: perspective of a developing country

“…In addition norms developed in United States and Canada needed modification when applied to United Kingdom. 17 Similarly in a developing country with limited infrastructure, significant W score should be interpreted cautiously. Injury Severity Score as an instrument to assess severity of injury is not sufficiently developed to account for difference in outcome of patients based on difference in treatment alone.…”

“…This explains overall low Injury Severity Scores with only 72 patients having score of more than 15, which is commonly accepted as a severe injury. 17 We recommend inclusion of emergency room deaths in developing countries to assess trauma care. Rapid transport affects survival; 60% of the deaths from trauma are reported to occur within four hours of injury and the prognosis of intracranial haemoharrage is markedly improved when treated within this time frame.…”

Quality Indicators for Evaluating Trauma Care

“…We identified 103 terms used to identify or describe QIs in our review. Although the field of quality improvement is fundamentally a process of change 10,18,37,49,62,86,109,113,122,140,145,149,151,178,187,194,196,207 ; 3 before-and-after case series 51,118,166 ; 2 nonrandomized controlled trials 16,205 ; and 1 cross-sectional study 17 Hospital mortality a 17 Cohort studies 7,43,49,52,63,83,86,88,105,128,145,149,161,191,192,194,204 73,74,166 ; and 2 case series 42,208 Abbreviations: CT, computed tomography; ED, emergency department. a Includes studies using non-risk-adjusted mortality, risk-adjusted mortality, and statistical outlier deaths.…”