Ulisse CORBANESE, *Rosella MARCON, Lucia CASAGRANDE, Clemente POSSAMAI, Antonio BALSARIN, Anna AVILA, Maria Antonietta DE ZOTTI, Lina STEFANI.
Servizio di Anestesia e Rianimazione, e *Divisione Pediatrica, Ospedale Civile S. Maria dei Battuti, via Brigata Bisagno, I-31015 Conegliano, Italy
Presented, in part, at the 9th European Congress on Intensive Care Medicine, Glasgow, UK, 24-28 September 1996
OBJECTIVE: To compare the performances of APACHE II score and TRISS method on our ICU trauma patients.
SETTING: a six-bed general ICU in a 500-bed community hospital.
DESIGN: Prospective, cohort study of consecutive admissions to ICU.
SUBJECTS: 190 severe trauma patients admitted from January 1992 to December 1993 were considered eligible. Patients without the ultimate outcome were excluded. One-hundred-sixty-two of patients with known ultimate outcome had complete TRISS data, and 108 of them had also complete APACHE II data.
OUTCOME MEASURE: Vital status at discharge from the last hospital that admitted the patient for the trauma being considered.
METHODS: APACHE II score and TRISS method were compared by using the Hosmer-Lemeshow goodness-of-fit statistics, ROC curve analysis, and likelihood ratios.
RESULTS: The Hosmer-Lemeshow goodness-of-fit results were =16.9, df=10, p=0.076 for the TRISS method, and =18.1, df=9, p=0.033 for APACHE II score. After the rearrangement from 10 to 3 (or 2) risk classes the 2 goodness-of-fit were =3.5, df=3, p=0.31 for TRISS method, and =10.7, df=2, p=0.0045 for APACHE II score. The area under the ROC curve was 0.963 (SEħ0.019) for TRISS with 95%CI from 0.921 to 0.986, and for APACHE II score was 0.902 (SEħ0.066) with 95%CI from 0.825 to 0.948. The difference between the two curves was nonsignificant (z=0.86, p=0.387), and the Absolute Performance Gain was 12.2% with 95%CI from -10.9 to 35.3%. The positive likelihood ratio (LHR) of TRISS method was 24.17 (95%CI 10.0-58.1), whereas the negative LHR was 0.14 (95%CI 0.05-0.42); for APACHE II the positive LHR was 12.7 (95%CI 3.6-44.5) and negative LHR was 0.52 (95%CI 0.23-1.16).
CONCLUSIONS: Both TRISS method and APACHE II score showed high discriminatory power, whereas the APACHE II calibration results were conflicting and probably influenced by the low number of cases. Moreover, the TRISS method showed larger positive and smaller negative likelihood ratios. In conclusion, the TRISS method showed slightly better performance than APACHE II score as audit system on our trauma population.
KEY WORDS: Intensive care units; trauma; outcome prediction; probability models
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