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Development and validation of the revised injury severity classification score for severely injured patients

Development and validation of the revised injury severity classification score for severely injured patients,10.1007/s00068-009-9122-0,European Journa

Development and validation of the revised injury severity classification score for severely injured patients   (Citations: 8)
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Abstract Introduction:   Trauma scores are often used for prognostication and the adjustment of mortality data. The appropriate consideration of identified prognostic factors is mandatory for a valid score with good outcome prediction properties. The Trauma Registry of the German Society for Trauma Surgery (TR-DGU) initially used the Trauma and Injury Severity Score (TRISS) but various reasons led to the development of a new scoring system, the Revised Injury Severity Classification (RISC). Patients and Methods:   A total of 2,008 severely injured patients with complete data documented in the TR-DGU during the period 1993–2000 were used to develop a new score. Patients were split into a development sample (n = 1,206) and a validation sample (n = 802). Multivariate logistic regression analysis was applied, and the results were compared with existing score systems. The quality of prediction was determined regarding discrimination (disparity, sensitivity, specificity, receiver operating characteristic [ROC] curve), precision (predicted versus observed mortality), and calibration (Hosmer–Lemeshow goodness-of-fit). Results:   Existing score systems (ISS, NISS, RTS, ASCOT, TRISS, Rixen) revealed areas under the ROC curve ranging from 0.767 to 0.877. The RISC combines 11 different components: age, NISS, head injury, severe pelvic injury, Glasgow Coma Scale, partial thromboplastin time (PTT), base excess, cardiac arrest, and indirect signs of bleeding (shock, mass transfusion, and low hemoglobin). The new RISC score reached significantly higher values of above 0.90 for the area under the ROC curve in both development and validation samples. Application to data from 2001 confirmed these results. Conclusion:   Outcome prediction including initial laboratory values was able to significantly improve the ability to discriminate between survivors and nonsurvivors. The adjustment of mortality rates should be based on the best available prediction model.
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    • ...Observed mortality in this retrospective analysis was lower than that predicted by the Revised Injury Severity Classification Score (RISC) [18] and Trauma Injury Severity Score (TRISS) [19]...

    Herbert Schöchlet al. Transfusion in trauma: thromboelastometry-guided coagulation factor co...

    • ... developed on the basis of data from the TR-DGU to calculate the probability of death for individual patients on the basis of the following 11 variables: age, new ISS, head injury, severe injuries of the extremities, Glasgow Coma Scale score, partial thromboplastin time, base excess, cardiac arrest and indirect signs of bleeding (systolic blood pressure <90 mmHg, hemoglobin <9 g/dl and massive transfusion during initial resuscitation) ...

    Sigune Peinigeret al. Balanced massive transfusion ratios in multiple injury patients with t...

    • ...Predicted mortality for each patient was estimated using the TRISS methodology modified for intubated patients [28] and the RISC score [29]...
    • ...To circumvent these limitations, observed mortality was also compared with the mortality predicted by the recently developed RISC score that combines age, New Injury Severity Score, head injury, severe pelvic injury, GCS, PTT, base excess, cardiac arrest, and indirect signs of bleeding (shock, mass transfusion and low haemoglobin) [29]...
    • ...In development and validation patient samples, the RISC score reached significantly higher values for receiver operating characteristic curves compared with TRISS [29]...
    • ...When applied to the patients included in the present study, this score revealed mortality rates lower than TRISS-predicted mortality, in agreement with initial reports [29]...

    Herbert Schöchlet al. Goal-directed coagulation management of major trauma patients using th...

    • ...Details on the TRISS and RISC score are given in [15,19-21] (TRISS) and [3,15,22] (RISC)...

    Karl-Georg Kanzet al. Trauma management incorporating focused assessment with computed tomog...

    • ...A further step towards improving trauma scores is presented by Lefering [8], who describes the revised injury severity classification score (RISC), an outcome prediction score that takes the individual pattern of injury into account...

    Otmar Trentzet al. Focus on: Diagnostic and prognosis of severely traumatized patients

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