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Titolo:
Validity of applying TRISS analysis to paediatric blunt trauma patients managed in a French paediatric level 1 trauma centre
Autore:
Orliaguet, G; Meyer, P; Blanot, S; Schmautz, E; Charron, B; Riou, B; Carli, P;
Indirizzi:
Hop Necker Enfants Malad, Dept Paediat Anaesthesiol & Crit Care, F-75743 Paris 15, France Hop Necker Enfants Malad Paris France 15 Care, F-75743 Paris 15, France Grp Hosp Pitie Salpetriere, Dept Anaesthesiol, F-75651 Paris, France Grp Hosp Pitie Salpetriere Paris France F-75651 l, F-75651 Paris, France Grp Hosp Pitie Salpetriere, Crit Care & Emergency Dept, F-75651 Paris 13, France Grp Hosp Pitie Salpetriere Paris France 13 ept, F-75651 Paris 13, France
Titolo Testata:
INTENSIVE CARE MEDICINE
fascicolo: 4, volume: 27, anno: 2001,
pagine: 743 - 750
SICI:
0342-4642(200104)27:4<743:VOATAT>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
PEDIATRIC PREHOSPITAL CARE; INJURY SEVERITY SCORE; MULTIPLE INJURIES; OUTCOME ANALYSIS; INTENSIVE-CARE; CHILDREN; PATTERNS; SURVIVAL; MODELS; URBAN;
Keywords:
children; trauma; outcome; TRISS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
45
Recensione:
Indirizzi per estratti:
Indirizzo: Orliaguet, G Hop Necker Enfants Malad, Dept Paediat Anaesthesiol & Crit Care, 149 Rue Sevres, F-75743 Paris 15, France Hop Necker Enfants Malad 149 Rue Sevres Paris France 15 ance
Citazione:
G. Orliaguet et al., "Validity of applying TRISS analysis to paediatric blunt trauma patients managed in a French paediatric level 1 trauma centre", INTEN CAR M, 27(4), 2001, pp. 743-750

Abstract

Objective: Using a weighted combination of the Revised Trauma Score (RTS),the Injury Severity Score (ISS), the type of injury (blunt or penetrating)and patient age, the TRISS method is used to calculate the probability of survival (ps) in trauma patients. The goal of this study was to compare theability of the American Major Trauma Outcome Study (MTOS) norm for adult blunt trauma patients (ADULT) and the specific norm for paediatric patients (PED) to estimate the ps of injured children using TRISS methodology. Design: Retrospective analysis using a paediatric trauma patient database. Setting: a French level 1 paediatric trauma centre. Patients: Four hundred seven consecutive paediatric blunt trauma patients,treated over a 3-year period. Measurements: The observed and expected survivals were compared, using theM, Wand Z scores, with both ADULT and FED. The W score is the number of survivors more or less than expected from the MTOS predictions for 100 patients. A Z score, which measures the significance of W, between -1.96 and +1.96, indicates no significant difference between observed and expected survivors. A value of M less than 0.88 indicates a disparity in the severity match between the study group and the MTOS group. We calculated the standardised W score (Ws), which represents the W score that would have been observed if the case mis of severity was identical to that of the MTOS group. Accordingly, a standardised Z score (Zs) was also calculated. In addition, we calculated the area under the receiver operating curve (aROC) using both norms, while calibration was also assessed by calculation of the Hosmer-Lemeshowgoodness-of-fit tests. Results: Using FED, the number of actual survivors (n = 364) was not significantly different from the MTOS (n = 358). The value of M: 0.65, indicateda disparity in the severity match between the study group and the MTOS group, due to a higher proportion of patients with lower ys (TRISS < 0.95, 52 vs 27 %. Ws was +1.06 % (95 % confidence interval -0.34 to 2.08) and Zs was1.48, indicating no significant difference from the MTOS. Using ADULT, thenumber of observed survivors (n = 364) was significantly higher than that expected (n = 354), with a W score of +2.70% (Z = +1.98, p < 0.05). There was a disparity in the severity match (M = 0.67) between the study group andthe MTOS group: due to a higher proportion of patients with lower ps. Ws was +1.32 % (95 % confidence interval -0.12 to 2.37) and Zs = +1.79 (NS), indicating no significant difference from the MTOS. The Hosmer-Lemeshow statistics indicated that ADULT (Cg = 7.24, p = 0.51; Hg = 4.45, p = 0.81) and PED (Cg = 6.08, p = 0.64; Hg = 3.55. p = 0.90) provided sufficient goodness-of-fit. There was no significant difference in the aROC of the TRISS between the two norms (0.935 <plus/minus> 0.050 vs 0.936 +/- Q.O50: NS),Conclusion: Both adult and paediatric norms were equally good predictors of the probability of survival of injured children, provided that Ws and Zs are used when there is a disparity in the severity match between the study group and the MTOS group.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/12/20 alle ore 22:41:17