Kei Ching Kevin Hung1,2, Chun Yu Lai1,2, Janice Hiu Hung Yeung1,2, Marc Maegele3, Po Shan Lily Chan4, Ming Leung5, Hay Tai Wong6, John Kit Shing Wong7, Ling Yan Leung1, Marc Chong8, Chi Hung Cheng1,2, Nai Kwong Cheung1,2, Colin Alexander Graham9,10. 1. Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong. 2. Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong. 3. Cologne-Merheim Medical Center (CMMC), Department of Trauma and Orthopedic Surgery, University Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany. 4. Trauma Service, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong. 5. Department of Surgery, Princess Margaret Hospital, 2‑10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong. 6. Trauma Service, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong Island, Hong Kong. 7. Trauma Service, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong. 8. School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong. 9. Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Shatin, Hong Kong. cagraham@cuhk.edu.hk. 10. Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, Hong Kong. cagraham@cuhk.edu.hk.
Abstract
PURPOSE: Hong Kong (HK) trauma registries have been using the Trauma and Injury Severity Score (TRISS) for audit and benchmarking since their introduction in 2000. We compare the mortality prediction model using TRISS and Revised Injury Severity Classification, version II (RISC II) for trauma centre patients in HK. METHODS: This was a retrospective cohort study with all five trauma centres in HK. Adult trauma patients with Injury Severity Score (ISS) > 15 suffering from blunt injuries from January 2013 to December 2015 were included. TRISS models using the US and local coefficients were compared with the RISC II model. The primary outcome was 30-day mortality and the area under the receiver operating characteristic curve (AUC) for tested models. RESULTS: 1840 patients were included, of whom 1236/1840 (67%) were male. Median age was 59 years and median ISS was 25. Low falls were the most common mechanism of injury. The 30-day mortality was 23%. RISC II yielded a superior AUC of 0.896, compared with the TRISS models (MTOS: 0.848; PATOS: 0.839; HK: 0.858). Prespecified subgroup analyses showed that all the models performed worse for age ≥ 70, ASA ≥ III, and low falls. RISC II had a higher AUC compared with the TRISS models in all subgroups, although not statistically significant. CONCLUSION: RISC II was superior to TRISS in predicting the 30-day mortality for Hong Kong adult blunt major trauma patients. RISC II may be useful when performing future audit or benchmarking exercises for trauma in Hong Kong.
PURPOSE: Hong Kong (HK) trauma registries have been using the Trauma and Injury Severity Score (TRISS) for audit and benchmarking since their introduction in 2000. We compare the mortality prediction model using TRISS and Revised Injury Severity Classification, version II (RISC II) for trauma centre patients in HK. METHODS: This was a retrospective cohort study with all five trauma centres in HK. Adult trauma patients with Injury Severity Score (ISS) > 15 suffering from blunt injuries from January 2013 to December 2015 were included. TRISS models using the US and local coefficients were compared with the RISC II model. The primary outcome was 30-day mortality and the area under the receiver operating characteristic curve (AUC) for tested models. RESULTS: 1840 patients were included, of whom 1236/1840 (67%) were male. Median age was 59 years and median ISS was 25. Low falls were the most common mechanism of injury. The 30-day mortality was 23%. RISC II yielded a superior AUC of 0.896, compared with the TRISS models (MTOS: 0.848; PATOS: 0.839; HK: 0.858). Prespecified subgroup analyses showed that all the models performed worse for age ≥ 70, ASA ≥ III, and low falls. RISC II had a higher AUC compared with the TRISS models in all subgroups, although not statistically significant. CONCLUSION: RISC II was superior to TRISS in predicting the 30-day mortality for Hong Kong adult blunt major trauma patients. RISC II may be useful when performing future audit or benchmarking exercises for trauma in Hong Kong.
Authors: Leonie de Munter; Suzanne Polinder; Koen W W Lansink; Maryse C Cnossen; Ewout W Steyerberg; Mariska A C de Jongh Journal: Injury Date: 2016-12-15 Impact factor: 2.586
Authors: Frederick B Rogers; Turner Osler; Margaret Krasne; Amelia Rogers; Eric H Bradburn; John C Lee; Daniel Wu; Nathan McWilliams; Michael A Horst Journal: J Trauma Acute Care Surg Date: 2012-08 Impact factor: 3.313