Should the New Injury Severity Score replace the Injury Severity Score in the Trauma and Injury Severity Score?

Ayd�n, �ule Akk�se; Bulut, Mehtap; �zg��, Halil; Ercan, �lker; T�rkmen, Nursel; Eren, B�lent; Esen, Mehmet

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Should the New Injury Severity Score replace the Injury Severity Score in the Trauma and Injury Severity Score? [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2008; 14(4): 308-312

Should the New Injury Severity Score replace the Injury Severity Score in the Trauma and Injury Severity Score?

�ule Akk�se Ayd�n¹, Mehtap Bulut², Halil �zg��³, �lker Ercan⁴, Nursel T�rkmen⁵, B�lent Eren⁶, Mehmet Esen⁷
¹Sule Akkose, Uluda� �niversitesi T�p Fak�ltesi Acil T�p AD, Bursa
²Mehtap Bulut, Uluda� �niversitesi T�p Fak�ltesi Acil T�p AD
³Halil �zg��, Uluda� �niversitesi T�p Fak�ltesi Genel Cerrahi AD
⁴�lker Ercan, Uluda� �niversitesi T�p Fak�ltesi Biyoistatistik AD
⁵Nursel T�rkmen, Uluda� �niversitesi T�p Fak�ltesi Adli T�p AD
⁶B�lent Eren, Uluda� �niversitesi T�p Fak�ltesi Adli T�p AD
⁷Mehmet Esen, Uluda� �niversitesi T�p Fak�ltesi Acil T�p AD

AMA�: Bu �al��mada, �oklu travmal� olgularda mortalitenin �ng�r�lmesinde hem Yaralanma �iddeti �l�e�i (ISS) ile Yeni Yaralanma �iddeti �l�e�i (NISS) etkinli�i kar��la�t�r�ld�, hem de �Travma ve Yaralanma �iddeti �l�e�i�nde (TRISS) ISS�nin yerini NISS alabilir mi?� sorusuna cevaplar arand�. GERE�-Y�NTEM: En az iki organ sistemi yaralanmas� olan 16 ya� �st� 550 travma olgusunun Revize Edilmi� Travma Skoru (RTS), ISS ve NISS�leri saptand�. Bu olgular�n TRISS�leri �nce �nerilen y�nteme g�re; ISS, RTS, ya� parametreleriyle (TRISS 1) sonra NISS, RTS ve ya� parametreleriyle (TRISS 2) hesapland�. Her skorun cut-off de�erleri ROC analizi ile belirlendi. Belirlenen cut-off de�erlerine g�re s�n�flanan travma skorlar�, di�er olas� risk fakt�rleriyle birlikte lojistik regresyon analizine konuldu ve mortaliteyi etkilemedeki risk d�zeyi ara�t�r�ld�.
BULGULAR: ISS, NISS, TRISS 1 ve TRISS 2�i�in ideal cut-off de�erleri s�ras�yla 21.0 (AUC: 0,907), 25.0 (AUC: 0,914), 90 (AUC: 0,934), 86 (AUC: 0,935) olarak hesapland�. Mortalitenin �ng�r�lmesinde ISS ile NISS ve TRISS 1 ile TRISS 2 aras�nda istatistiksel olarak anlaml� bir farkl�l�k saptanmad�. SONU�: Sonu� olarak, mortaliteyi �ng�rmede ISS ile NISS aras�nda anlaml� bir fark yoktur. TRISS modelinde ISS yerine NISS kullan�lmas� anlaml� bir farkl�l��a yol a�mamaktad�r ve bu nedenle �nerilebilir.

Anahtar Kelimeler: Yaralanma �iddeti �l�e�i, Yeni Yaralanma �iddeti �l�e�i; Travma ve Yaralanma �iddeti �l�e�i.

Should New Injury Severity Score Replace Injury Severity Score in Trauma and Injury Severity Score ?

�ule Akk�se Ayd�n¹, Mehtap Bulut², Halil �zg��³, �lker Ercan⁴, Nursel T�rkmen⁵, B�lent Eren⁶, Mehmet Esen⁷
¹Sule Akkose Department Of Emergency Medicine, Uludag University Medical School, Bursa, Turkey
²Mehtap Bulut, Department Of Emergency Medicine
³Halil Ozguc, Department Of General Surgery
⁴Ilker Ercan, Department Of Biostatistic
⁵Nursel Turmen, Department Of Forensic Medicine
⁶Bulent Eren, Department Of Forensic Medicine
⁷Mehmet Esen, Department Of Emergency Medicine

BACKGROUND: This study was performed to compare the efficacies of Injury Severity Score (ISS) and New Injury Severity Score (NISS), and to investigate whether replacing ISS with NISS in Trauma and Injury Severity Score (TRISS) changes the predictive power for mortality. METHODS: We retrospectively analyzed 550 patients aged over 16 years seen in our center over a period of four years who had injuries in at least two organ systems. The ISS, NISS and TRISS were calculated for each patient. TRISS was calculated in two ways: TRISS 1 with age, Revised Trauma Score (RTS) and ISS, and TRISS 2 with age, RTS and NISS. The cut-off values for TRISS 1, TRISS 2, ISS and NISS were determined by ROC analysis. RESULTS: The ideal cut-off values for the prediction of mortality were 21.0 (AUC: 0.907) for ISS and 25.0 (AUC: 0.914) for NISS. There was no statistically significant difference between the ROC curves of ISS and NISS. The ideal cut-off values for predicting mortality were 90 (AUC: 0.934) for TRISS 1 and 86 (AUC: 0.935) for TRISS 2. There was no statistically significant difference between the ROC curves of TRISS 1 and TRISS 2. CONCLUSION: Use of NISS instead of ISS in the TRISS model demonstrated no significant difference, and it can thus be recommended for use.

Keywords: Injury Severity Score, New Injury Severity Score; Trauma and Injury Severity Score.

Sorumlu Yazar: �ule Akk�se Ayd�n, T�rkiye
Makale Dili: �ngilizce

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