Ulisse CORBANESE, Lucia CASAGRANDE, Clemente POSSAMAI, *Rosella MARCON, Antonio BALSARIN, Anna AVILA, Maria Antonietta DE ZOTTI, Lina STEFANI, Giacomo VENIER.
Clinical Intensive Care 1997; 8: 116-121
Servizio di Anestesia e Rianimazione, e *Divisione Pediatrica, Ospedale Civile S. Maria dei Battuti, via Brigata Bisagno, I-31015 Conegliano, Italy
Objective: to describe the pattern of injuries of our ICU trauma patients, to identify the features related to a poor outcome and to audit severe trauma care in our hospital using the TRISS method.
Design: prospective, cohort study of consecutive admissions to ICU.
Setting: a six-bed general ICU in a 500-bed general hospital.
Subjects: 190 severe trauma patients admitted from January 1992 to December 1993 were considered eligible. Patients without the data necessary to calculate the TRISS probability of survival, or where the outcome was unknown, were excluded. 162 patients were included in the study.
Interventions: none.
Measurements and main results: 110 (67.9%) patients underwent a severe trauma (ISS > 15). 65 (40.1%) had severe head injury (AIS 3), and 54 (33.3%) had a GCS less than 9 during the first 24 hours. 61 (37.6%) patients had severe chest trauma, and 28 (17.2%) severe abdominal injury. 52 (32.1%) patients had severe injuries to pelvis and/or extremities. Non-survivors were older than survivors and had significantly higher APACHE II score, ISS, and AIS of the head. Moreover, non-survivors had lower RTS and GCS in the first 24 hours from admission, and a shorter ICU stay. A GCS 8 was a strong predictor of in-hospital death (OR 28.7, 95%CI 6.3-129.7), as well as an age > 65 years (OR 4.6, 95%CI 1.78-12.2), and haemorrhagic shock (OR 4.22, 95%CI 1.6-11.0). There were 142 (87.6%) ICU survivors, and 141 (87.0%) were discharged alive from the hospital. The TRISS method predicted a mean survival rate of 82.1%±28.9% (95%CI 77.8- 86.5%); the W value was 4.85, and Flora's Z statistic was 2.369 (p=0.017). The standardised Wswas 5.96 (95%CI 3.31-8.61), and Zs was 4.415 (p < 0.0001).
Conclusions: Our data show once again that hospital mortality is strongly associated with severe head injury, advanced age and haemorrhagic shock. Flora Z statistic shows that the mortality in the trauma population considered was significantly lower than the death rate predicted by MTOS norms. This result is also confirmed by the standardised Zs statistic. Due to the relatively small number of patients with operable intra-cranial injuries included, some caution in extending these results to such an important group of trauma patients is advisable.
ABBREVIATIONS: GCS = Glasgow Coma Scale, ISS = Injury Severity Score, AIS = Abbreviated Injury Scale, RTS = Revised Trauma Score.
KEY WORDS: Probability models; multiple trauma; mortality; intensive care units; trauma severity indices.
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