Predicting Survival after Trauma: a Comparison of TRISS and ASCOT in the Netherlands |
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Authors: | Sander P G Frankema Michael J R Edwards Ewout W Steyerberg and Arie B van Vugt |
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Affiliation: | (1) Department of General Surgery and Traumatology, Erasmus MC Rotterdam, The Netherlands, NL;(2) Department of General Surgery, Rode Kruis Hospital, The Hague, The Netherlands, NL;(3) Department of Public Health, Erasmus MC Rotterdam, The Netherlands, NL |
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Abstract: | Background: Evaluating the performance of a trauma system may be attempted by comparing outcome in different trauma populations. Controlling
for injury severity is a necessity for such evaluations. We compare two current models for doing so: the “Trauma and Injury
Severity Score” (TRISS) and “A Severity Characterization Of Trauma” (ASCOT).
Material and Methods: This study of high-energy trauma victims took place in Leiden, the Netherlands, between 1993 and 1998. Using the Hosmer-Lemeshow
(HL) test and receiver operator characteristic (ROC) analysis, the TRISS and ASCOT models were compared for calibration and
discrimination.
Results: 1,024 patients, with an average Injury Severity Score (ISS) of 13.5, were eligible for inclusion. Blunt trauma was the predominant
cause of injuries. Both models gave accurate, though pessimistic, results in predicting the actual number of fatalities (n
= 71). The HL test indicated a sufficient fit for the ASCOT model (p = 0.28) and an insufficient fit (p = 0.02) for TRISS.
The ROC curves were nearly identical (0.97). Including age as a linear variable, instead of using the current age groups,
resulted in an improved discriminative power of the models.
Conclusions: The ASCOT model proved superior over TRISS in its accuracy to estimate of survival chances. This difference was most evident
for victims with an estimated survival chance of 60–90%. Future national trauma researchers should therefore collect ASCOT
data. Improved ASCOT models could be developed, with age as a linear variable.
Received: April 25, 2002; revision accepted: September 17, 2002
Correspondence Address Prof. Arie B. van Vugt, MD, PhD, Department of General Surgery and Traumatology, Erasmus MC Rotterdam, Dr. Molewaterplein
40, Postbus 2040, 3000 CA Rotterdam, The Netherlands, Phone (+31/10) 463-5735, Fax -4757, e-mail: vanvugt@hlkd.azr.nl |
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Keywords: | Trauma Prognosis Mortality Abbreviated Injury Scale TRISS ASCOT |
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