BACKGROUND: Prehospital trauma patient field intubations and paralyzations, using neuromuscular blocking agents before emergency department respiratory and neurologic assessments are made, bias assessments and outcome evaluations using probability-of-survival models, such as TRISS and A Severity Characterization of Trauma (ASCOT). We present a newly developed "TRISS-like" probability-of-survival model for intubated blunt- and penetrating-injured patient assessment. METHODS: From a population of 51397 consecutively admitted trauma patients, this study used all 5740 (11.2% of the total injured population) intubated patients with complete data from a statewide trauma registry from October 1, 1993, to September 30, 1996. Model performance was evaluated using standard calibration and discrimination measures and z and W statistics of significance. RESULTS: The new model accurately predicted survival for blunt- and penetrating-injured intubated patients and is applicable to 11 etiologic patient populations. CONCLUSION: Study findings suggest that the new TRISS-like model should be used to assess both blunt- and penetrating-injured intubated patients. Use of this new model provides an analytical method for addressing a significant limitation of both the standard TRISS and ASCOT models, which are not applicable to intubated injured patient assessment. In addition, use of this model will complement TRISS/ASCOT assessments of nonintubated trauma patients and thus permit appropriate assessments for both intubated and nonintubated injured patient study populations.
BACKGROUND: Prehospital traumapatient field intubations and paralyzations, using neuromuscular blocking agents before emergency department respiratory and neurologic assessments are made, bias assessments and outcome evaluations using probability-of-survival models, such as TRISS and A Severity Characterization of Trauma (ASCOT). We present a newly developed "TRISS-like" probability-of-survival model for intubated blunt- and penetrating-injured patient assessment. METHODS: From a population of 51397 consecutively admitted traumapatients, this study used all 5740 (11.2% of the total injured population) intubated patients with complete data from a statewide trauma registry from October 1, 1993, to September 30, 1996. Model performance was evaluated using standard calibration and discrimination measures and z and W statistics of significance. RESULTS: The new model accurately predicted survival for blunt- and penetrating-injured intubated patients and is applicable to 11 etiologic patient populations. CONCLUSION: Study findings suggest that the new TRISS-like model should be used to assess both blunt- and penetrating-injured intubated patients. Use of this new model provides an analytical method for addressing a significant limitation of both the standard TRISS and ASCOT models, which are not applicable to intubated injured patient assessment. In addition, use of this model will complement TRISS/ASCOT assessments of nonintubated traumapatients and thus permit appropriate assessments for both intubated and nonintubated injured patient study populations.
Authors: Herbert Schöchl; Ulrike Nienaber; Marc Maegele; Gerald Hochleitner; Florian Primavesi; Beatrice Steitz; Christian Arndt; Alexander Hanke; Wolfgang Voelckel; Cristina Solomon Journal: Crit Care Date: 2011-03-04 Impact factor: 9.097