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        "titulo" => "Predicci&#243;n de la mortalidad a trav&#233;s de la metodolog&#237;a TRISS en el Registro Espa&#241;ol de Trauma en UCI &#40;RETRAUCI&#41;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Trauma registries constitute an useful tool for monitoring trauma patient care&#44; since they accurately reflect management and care in different settings&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This allows not only improvement of individual treatment but also reorganization of the general care profile and logistics applied in the management of severe trauma patients&#44; as well as comparisons among different registries for benchmarking purposes&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The outcome of trauma patients is mainly determined by the initial severity of the physiological and anatomical injuries secondary to trauma itself&#46; Severity of injury can be evaluated by severity scales obtained from the analysis of large cohorts of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Of all the prognostic scores used in trauma patients&#44; the <span class="elsevierStyleItalic">Trauma and Injury Severity Score &#40;TRISS&#41;</span> is currently the most widely used tool&#44; and is regarded as the standard method&#46; In this regard&#44; TRISS methodology determines the probability of survival based on a logistic regression model that includes anatomical evaluation by means of the Injury Severity Score &#40;ISS&#41;&#44; physiological evaluations using the Revised Trauma Score &#40;RTS&#41;&#44; patient age and type of trauma &#40;blunt or penetrating&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The following equation is applied&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0015" class="elsevierStylePara elsevierViewall">Coefficients <span class="elsevierStyleItalic">b</span><span class="elsevierStyleInf">0</span>&#8211;<span class="elsevierStyleItalic">b</span><span class="elsevierStyleInf">3</span> were derived from the logistic regression analysis of the American database MTOS &#40;<span class="elsevierStyleItalic">US Major Trauma Outcome Study</span>&#41;&#46; This was not a population-based database&#44; participation was voluntary&#44; and it involved hospitals with a special interest in trauma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pilot phase of the Spanish Intensive Care Unit Trauma Registry &#40;RETRAUCI&#41; has been recently conducted in 13 Intensive Care Units &#40;ICUs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our objective was to validate TRISS methodology almost 30 years later as an auditing tool for mortality prediction in the Spanish ICU Trauma Registry&#44; taking into consideration the mechanisms of injury &#40;blunt or penetrating&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The pilot phase of the RETRAUCI was conducted from 23 November 2012 to 31 January 2015&#46; Thirteen ICUs distributed throughout Spain collected data&#46; The RETRAUCI is endorsed by the Trauma and Neurointensive Care Working Group of the Spanish Society of Intensive Care Medicine &#40;SEMICYUC&#41;&#46; Ethics Committee approval for the registry was obtained&#46; No specific interventions were required for this study&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">We studied all patients admitted to the participating ICUs during the pilot phase of the RETRAUCI due to traumatic disease&#46; In all cases&#44; data on epidemiology&#44; acute management&#44; resource utilization and outcome were recorded&#46; Patients were followed-up on until hospital discharge for outcome as a dichotomous variable &#40;alive or dead&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The following exclusion criteria were applied&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Missing data for calculating RTS or ISS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Outcome at hospital discharge not known for any reason&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data collection</span><p id="par0050" class="elsevierStylePara elsevierViewall">Data used for calculating RTS &#40;respiratory rate&#44; systolic blood pressure and Glasgow coma score&#41; were obtained from first medical attention before initiating resuscitation and&#47;or mechanical ventilation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Data used for calculating the ISS were prospectively collected by the intensivist in charge of the patient after ICU admission&#44; based on the Abbreviated Injury Scale &#40;updated in 2008&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Quantitative data are reported as means &#40;standard deviation&#41; &#40;SD&#41; and qualitative data as absolute frequencies and percentages&#46; Probability of survival was calculated according to TRISS methodology<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a> and secondarily&#44; predicted mortality was calculated as follows&#58; &#40;100 &#8211; predicted probability of survival&#41;&#46; To evaluate the validity of the model&#44; we studied discrimination and calibration in the whole sample and distributed according to blunt or penetrating mechanisms of injury&#46; Discrimination refers to the ability to distinguish between patients who die and those that survive&#46; Accordingly&#44; if the model predicts a mortality rate of 20&#37;&#44; discrimination is perfect if the observed mortality is 20&#37;&#46; It can be evaluated using receiver operating characteristic &#40;ROC&#41; curves and the area under the curves &#40;AUCs&#41; &#40;95&#37; confidence interval&#44; 95&#37; CI&#41;&#46; The greater the area&#44; the better the discrimination&#46; Sensitivity &#40;S&#41;&#44; specificity &#40;Sp&#41;&#44; and the positive &#40;PPV&#41; and negative predictive values &#40;NPV&#41; were recorded in each case&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The calibration of a prognostic model evaluates the concordance between the probability observed in the sample and the probability predicted by the model&#44; describing how the prognostic scale works over wide ranges of predicted mortality&#46; It is evaluated using the Hosmer&#8211;Lemeshow &#40;HL&#41; goodness-of-fit test&#44; in patients with low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#8211;50&#37;&#41; and high predicted mortality rates &#40;&#62;50&#37;&#41;&#46; A probability of close to 1 represents better adjustment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The SPSS<span class="elsevierStyleSup">&#174;</span> version 20 statistical package &#40;IBM Corporation 2011&#41; was used throughout&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 2242 patients formed the global cohort of the pilot phase of the RETRAUCI&#46; Patient dropout from the sample was due to different reasons&#44; the most important being inability to determine hospital outcome in 21&#46;1&#37; of the cases&#44; due to patient transfer to the corresponding reference hospital&#46; In most cases&#44; transfer was done to another country&#44; making follow-up impossible&#46; The flowchart in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> summarizes the final sample of 1405 patients included in the study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The mean patient age was 46&#46;7 &#40;19&#46;4&#41; years&#44; and 80&#46;3&#37; were males&#46; The mean ISS score was 21&#46;3 &#40;12&#46;1&#41;&#46; A total of 1305 patients suffered blunt trauma &#40;92&#46;9&#37;&#41; as the main mechanism of injury&#44; while the remaining 100 patients &#40;7&#46;1&#37;&#41; presented penetrating trauma&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the data referred to patient epidemiology&#44; acute management&#44; resource utilization and main outcome&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The observed mortality rate &#40;including ICU and post-ICU stay&#41; was 18&#37; &#40;253 patients&#41;&#44; with a predicted mortality rate of 16&#46;9&#37;&#46; In patients with blunt trauma&#44; the observed and predicted mortality rates were 18&#46;5&#37; and 17&#46;1&#37;&#44; respectively&#46; In penetrating trauma&#44; the observed and predicted mortality rates were 12&#37; and 14&#46;2&#37;&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution of patients who died in groups with low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#8211;50&#37;&#41; and high predicted mortality &#40;&#62;50&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The global sample of 1405 patients presented an area under the ROC curve of 0&#46;889 &#40;95&#37; CI&#58; 0&#46;867&#8211;0&#46;911&#41;&#44; with S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#46;9&#37;&#44; Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#46;2&#37;&#44; PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#46;6&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#46;9&#37;&#46; Patients with blunt trauma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; presented an area under the ROC curve of 0&#46;887 &#40;95&#37; CI&#58; 0&#46;864&#8211;0&#46;910&#41;&#44; with S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#46;6&#37;&#44; Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#46;2&#37;&#44; PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#46;3&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#46;6&#37;&#44; while patients with penetrating trauma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; presented an area under the ROC curve of 0&#46;919 &#40;95&#37; CI&#58; 0&#46;859&#8211;0&#46;979&#41;&#44; with S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#46;3&#37;&#44; Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#46;5&#37;&#44; PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#46;6&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#46;4&#37;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The results of the Hosmer&#8211;Lemeshow &#40;HL&#41; goodness-of-fit test&#44; in both in the total cohorts of patients of patients and distributed according to the mechanism of trauma &#40;blunt or penetrating&#41; are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; The correlation between predicted and observed mortality is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Our study shows that TRISS methodology applied in the sample of patients included in the pilot phase of the RETRAUCI presented good levels of discrimination with inadequate calibration&#44; especially in patients with blunt trauma&#46; Penetrating trauma showed better discrimination and good calibration&#46; Altogether&#44; these results suggest that newly calibrated &#40;<span class="elsevierStyleItalic">b</span> coefficient&#41; scales are necessary in our setting&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Our sample of patients offers an initial picture of patients with severe trauma admitted to the ICUs of our setting&#44; taking into account the severity of injury&#44; the care provided&#44; length of stay and mortality&#46; These Units represent level I and II centers&#46; Such patients usually present high ISS values&#44; important resource utilization&#44; and high mortality&#46; The TRISS methodology is based on the degree of anatomical injury &#40;ISS&#41;&#44; physiological response &#40;RTS&#41; and functional reserve &#40;age&#41;&#46; It was first developed in the 1980s through several logistic regression models<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9</span></a> with different b coefficients considering blunt or penetrating injuries&#46; Several updates have been made since then&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">When applied to our patients&#44; TRISS showed good discrimination with inadequate calibration &#8211; a fact that limits the use of this prognostic model&#46; This observation is consistent with other studies&#44; and in general&#44; with other prognostic scores in the ICU setting&#44; where the main shortcoming corresponds to inadequate calibration despite good discrimination&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It must be noted that in our sample of patients&#44; those with penetrating injury showed good calibration&#46; This fact is consistent with previous studies differentiating between blunt and penetrating trauma&#46; In the latter type of trauma&#44; discrimination and calibration is better&#44; perhaps due to lesser improvement in their specific care&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Poor calibration and discrimination does not necessarily refer to the quality of the care provided but rather to incorrect application of the model to a population with specific characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In addition&#44; TRISS is considered to present lower sensitivity for blunt trauma&#44; since it underestimates brain injury&#59; does not consider multiple injuries in the same anatomical area&#59; and does not consider age on an individual basis&#46; In our sample of patients&#44; on taking into account the different mortality groups&#44; TRISS underestimated mortality when the predicted mortality was &#60;60&#37; and overestimated it when the predicted mortality was &#62;60&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Mortality prediction according to TRISS has therefore been questioned<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#58; its clinical application has shown opposite results&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> especially when used in non-MTOS patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> The best way to increase its predictive value is to use local correction factors to adjust for <span class="elsevierStyleItalic">b</span> coefficients&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> The results of our study confirm that newly developed b coefficients are needed for trauma patients admitted to Spanish ICUs&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">New scores have been developed in an attempt to improve the predictive value of TRISS&#46; Some of them are the ASCOT &#40;A Severity Characterization Of Trauma&#41;&#44; which includes gender&#44; 5 age categories and different anatomic scales&#59; the ICISS &#40;International Classification of Diseases Ninth revision based injury severity score&#41;&#59; the NISS &#40;New Injury Severity Score&#41;&#59; the RISC &#40;Revised Injury Severity Classification score&#41;&#59; or the pediatric BIG score&#46; However&#44; although they have slightly improved the predictive ability of TRISS methodology&#44; the latter remains the most widely used tool in clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;20&#44;23&#8211;25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study has a number of limitations &#8211; some attributable to the TRISS model itself&#44; and other specific of our sample&#46; The most relevant are &#40;a&#41; the limited number of patients for this kind of analysis despite the multicenter nature of the study&#46; This corresponds to the pilot phase of the RETRAUCI&#46; With a growing number of centers recruiting patients&#44; we expect to solve this issue in the future&#59; &#40;b&#41; up to 21&#37; of the patients were lost for hospital outcome evaluation&#46; This was due to the large number of patients from different countries that are admitted to our ICUs and are subsequently transferred to their reference hospitals at home&#44; thereby making follow-up impossible&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In sum&#44; TRISS methodology in the Spanish RETRAUCI showed good levels of discrimination&#44; with inadequate calibration&#44; especially in blunt trauma&#46; Penetrating trauma showed better discrimination and good calibration&#46; Altogether&#44; these results suggest that newly calibrated &#40;<span class="elsevierStyleItalic">b</span> coefficient&#41; scales are necessary in our setting&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Collaborators</span><p id="par0140" class="elsevierStylePara elsevierViewall">Carlos Garc&#237;a-Fuentes&#44; Luis Terceros-Almanza &#40;Hospital Universitario 12 Octubre&#41;&#44; Iker Garc&#237;a-S&#225;ez&#44; Ruth Salaberria-Udabe &#40;Hospital Universitario de Donostia&#41;&#44; Cecilia Carbayo-G&#243;rriz &#40;Complejo Hospitalario de Torrec&#225;rdenas&#41;&#44; Carmen Corcobado-M&#225;rquez &#40;Hospital General Universitario de Ciudad Real&#41;&#44; Javier Trujillano-Cabello &#40;Hospital Universitari Arnau de Vilanova&#41;&#44; Eduardo Mi&#241;ambres-Garc&#237;a &#40;Hospital Universitario Marqu&#233;s de Valdecilla&#41;&#44; Amanda Lesmes-Gonz&#225;lez &#40;Hospital Universitario de Getafe&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">RETRAUCI received funding from the <span class="elsevierStyleGrantSponsor" id="gs1"><span class="elsevierStyleItalic">Fundaci&#243;n Mutua Madrile&#241;a</span></span> during three years for the development of a web-based database&#44; granted to the principal investigator &#40;Dr&#46; Chico-Fern&#225;ndez&#44; <span class="elsevierStyleGrantNumber" refid="gs1">AP117892013</span>&#41;&#44; on behalf of the Trauma and Neurointensive Care Working Group of the SEMICYUC&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">All authors listed in the study declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To validate <span class="elsevierStyleItalic">Trauma and Injury Severity Score &#40;TRISS&#41;</span> methodology as an auditing tool in the Spanish ICU Trauma Registry &#40;RETRAUCI&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; multicenter registry evaluation was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thirteen Spanish Intensive Care Units &#40;ICUs&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Individuals with traumatic disease and available data admitted to the participating ICUs&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015&#46; Discrimination was evaluated using receiver operating characteristic &#40;ROC&#41; curves and the corresponding areas under the curves &#40;AUCs&#41; &#40;95&#37; CI&#41;&#44; with calibration using the Hosmer&#8211;Lemeshow &#40;HL&#41; goodness-of-fit test&#46; A value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered significant&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Predicted and observed mortality&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1405 patients were analyzed&#46; The observed mortality rate was 18&#37; &#40;253 patients&#41;&#44; while the predicted mortality rate was 16&#46;9&#37;&#46; The area under the ROC curve was 0&#46;889 &#40;95&#37; CI&#58; 0&#46;867&#8211;0&#46;911&#41;&#46; Patients with blunt trauma &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1305&#41; had an area under the ROC curve of 0&#46;887 &#40;95&#37; CI&#58; 0&#46;864&#8211;0&#46;910&#41;&#44; and those with penetrating trauma &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41; presented an area under the curve of 0&#46;919 &#40;95&#37; CI&#58; 0&#46;859&#8211;0&#46;979&#41;&#46; In the global sample&#44; the HL test yielded a value of 25&#46;38 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#58; 27&#46;35 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; in blunt trauma and 5&#46;91 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;658&#41; in penetrating trauma&#46; TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination&#44; with inadequate calibration &#8211; particularly in blunt trauma&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar el <span class="elsevierStyleItalic">Trauma and Injury Severity Score</span> &#40;TRISS&#41; como instrumento de auditor&#237;a en el Registro Espa&#241;ol de Trauma en UCI&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Evaluaci&#243;n prospectiva de un registro multic&#233;ntrico&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Trece UCI espa&#241;olas&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Individuos con enfermedad traum&#225;tica y datos completos ingresados en las UCI participantes&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparamos la mortalidad predicha por el TRISS con la observada en la fase piloto del Registro Espa&#241;ol de Trauma en UCI desde noviembre de 2012 hasta enero de 2015&#46; La discriminaci&#243;n se evalu&#243; mediante curvas <span class="elsevierStyleItalic">receiver operating characteristic</span> y el valor bajo su &#225;rea &#40;IC 95&#37;&#41;&#44; y la calibraci&#243;n&#44; mediante el test de bondad de ajuste de Hosmer-Lemeshow&#46; Un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 se consider&#243; significativo&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Principales variables de inter&#233;s</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Mortalidad observada y predicha&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Analizamos 1&#46;405 pacientes&#46; La mortalidad observada fue del 18&#37; &#40;253 pacientes&#41;&#44; mientras que la predicha fue del 16&#44;9&#37;&#46; El &#225;rea bajo la curva <span class="elsevierStyleItalic">receiver operating characteristic</span> fue de 0&#44;889 &#40;IC 95&#37; 0&#44;867-0&#44;911&#41;&#46; Los pacientes con trauma cerrado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;305&#41; presentaron un &#225;rea bajo la curva <span class="elsevierStyleItalic">receiver operating characteristic</span> de 0&#44;887 &#40;IC 95&#37; 0&#44;864-0&#44;910&#41;&#44; y aquellos con traumatismo penetrante &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#44; de 0&#44;919 &#40;IC 95&#37; 0&#44;859-0&#44;979&#41;&#46; En la muestra global&#44; el test de Hosmer-Lemeshow mostr&#243; un valor de 25&#44;38 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; siendo de 27&#44;35 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; en trauma cerrado y de 5&#44;91 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;658&#41; en trauma penetrante&#46; La metodolog&#237;a TRISS infraestim&#243; la mortalidad en los pacientes con mortalidad predicha baja y la sobreestim&#243; en pacientes con mortalidad predicha elevada&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La aplicaci&#243;n de la metodolog&#237;a TRISS en el trauma grave ingresado en las UCI espa&#241;olas mostr&#243; buenos niveles de discriminaci&#243;n y una calibraci&#243;n inadecuada&#44; especialmente en el traumatismo cerrado&#46;</p></span>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1405&#41;<br>Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma mechanism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">394 &#40;28&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aggression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Occupational accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Self-injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sports-related&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;5&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;4&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Out-of-hospital medical support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1240 &#40;88&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ISS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">429 &#40;30&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#8211;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">600 &#40;42&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">342 &#40;24&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemodynamically stable-admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">878 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICP monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">233 &#40;18&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood transfusion 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">351 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">806 &#40;66&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilation &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;7 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MOF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-ICU stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Global mortality&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted mortality&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;74&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1390393.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients who died in the groups with low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#8211;50&#37;&#41; and high predicted mortality &#40;&#62;50&#37;&#41;&#46;</p>"
        ]
      ]
      5 => array:8 [
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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            "identificador" => "at3"
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        ]
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          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>number of patients&#59; df&#44; degrees of freedom&#59; H-L&#44; Hosmer&#8211;Lemeshow goodness-of-fit test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted mortality deciles &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observed survivors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted survivors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observed dead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted dead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">H&#8211;L<br>df<br><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Total sample &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1405&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;9&#8211;1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46;3&#8211;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">149&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46;3&#8211;3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46;6&#8211;5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#46;8&#8211;9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>9&#46;2&#8211;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>15&#46;1&#8211;31&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;38<br>8<br>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>31&#46;8&#8211;63&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>63&#46;7&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Blunt trauma &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1305&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;3&#8211;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;8&#8211;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46;1&#8211;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46;8&#8211;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46;1&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#46;3&#8211;7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>7&#46;9&#8211;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0155" class="elsevierStylePara elsevierViewall">The authors are indebted to Vicente G&#243;mez-Tello &#40;Hospital Moncloa&#44; Madrid&#46; Working Groups Coordinator&#44; SEMICYUC&#41;&#44; Andr&#233;s J&#46; Chac&#243;n &#40;Project Manager&#44; Xferic&#41; and Miguel Ferrero-Fern&#225;ndez &#40;Department of Informatics&#44; SEMICYUC&#41; for their invaluable help in developing the registry and the web-based tool&#46;</p>"
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Original
Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI)
Predicción de la mortalidad a través de la metodología TRISS en el Registro Español de Trauma en UCI (RETRAUCI)
M. Chico-Fernándeza, J.A. Llompart-Poub,
Corresponding author
juanantonio.llompart@ssib.es
ja_llompart@hotmail.com

Corresponding author.
, M. Sánchez-Casadoc, F. Alberdi-Odriozolad, F. Guerrero-Lópeze, M.D. Mayor-Garcíaf, J.J. Egea-Guerrerog, J.F. Fernández-Ortegah, A. Bueno-Gonzálezi, J. González-Robledoj, L. Servià-Goixartk, J. Roldán-Ramírezl, M.Á. Ballesteros-Sanzm, E. Tejerina-Alvarezn, F.I. Pino-Sáncheze, J. Homar-Ramírezb, in representation of the Trauma and Neurointensive Care Working Group of the SEMICYUC
a Trauma and Emergencies ICU, Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
b Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
c Department of Intensive Care Medicine, Hospital Virgen de la Salud, Toledo, Spain
d Department of Intensive Care Medicine, Hospital Universitario de Donostia, San Sebastián, Spain
e Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
f Department of Intensive Care Medicine, Complejo Hospitalario de Torrecárdenas, Almería, Spain
g Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
h Department of Intensive Care Medicine, Hospital Universitario Carlos Haya, Málaga, Spain
i Department of Intensive Care Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
j Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
k Department of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
l Department of Intensive Care Medicine, Complejo Hospitalario de Pamplona, Navarra, Spain
m Department of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
n Department of Intensive Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Trauma registries constitute an useful tool for monitoring trauma patient care&#44; since they accurately reflect management and care in different settings&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This allows not only improvement of individual treatment but also reorganization of the general care profile and logistics applied in the management of severe trauma patients&#44; as well as comparisons among different registries for benchmarking purposes&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The outcome of trauma patients is mainly determined by the initial severity of the physiological and anatomical injuries secondary to trauma itself&#46; Severity of injury can be evaluated by severity scales obtained from the analysis of large cohorts of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Of all the prognostic scores used in trauma patients&#44; the <span class="elsevierStyleItalic">Trauma and Injury Severity Score &#40;TRISS&#41;</span> is currently the most widely used tool&#44; and is regarded as the standard method&#46; In this regard&#44; TRISS methodology determines the probability of survival based on a logistic regression model that includes anatomical evaluation by means of the Injury Severity Score &#40;ISS&#41;&#44; physiological evaluations using the Revised Trauma Score &#40;RTS&#41;&#44; patient age and type of trauma &#40;blunt or penetrating&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The following equation is applied&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0015" class="elsevierStylePara elsevierViewall">Coefficients <span class="elsevierStyleItalic">b</span><span class="elsevierStyleInf">0</span>&#8211;<span class="elsevierStyleItalic">b</span><span class="elsevierStyleInf">3</span> were derived from the logistic regression analysis of the American database MTOS &#40;<span class="elsevierStyleItalic">US Major Trauma Outcome Study</span>&#41;&#46; This was not a population-based database&#44; participation was voluntary&#44; and it involved hospitals with a special interest in trauma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pilot phase of the Spanish Intensive Care Unit Trauma Registry &#40;RETRAUCI&#41; has been recently conducted in 13 Intensive Care Units &#40;ICUs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our objective was to validate TRISS methodology almost 30 years later as an auditing tool for mortality prediction in the Spanish ICU Trauma Registry&#44; taking into consideration the mechanisms of injury &#40;blunt or penetrating&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The pilot phase of the RETRAUCI was conducted from 23 November 2012 to 31 January 2015&#46; Thirteen ICUs distributed throughout Spain collected data&#46; The RETRAUCI is endorsed by the Trauma and Neurointensive Care Working Group of the Spanish Society of Intensive Care Medicine &#40;SEMICYUC&#41;&#46; Ethics Committee approval for the registry was obtained&#46; No specific interventions were required for this study&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">We studied all patients admitted to the participating ICUs during the pilot phase of the RETRAUCI due to traumatic disease&#46; In all cases&#44; data on epidemiology&#44; acute management&#44; resource utilization and outcome were recorded&#46; Patients were followed-up on until hospital discharge for outcome as a dichotomous variable &#40;alive or dead&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The following exclusion criteria were applied&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Missing data for calculating RTS or ISS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Outcome at hospital discharge not known for any reason&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data collection</span><p id="par0050" class="elsevierStylePara elsevierViewall">Data used for calculating RTS &#40;respiratory rate&#44; systolic blood pressure and Glasgow coma score&#41; were obtained from first medical attention before initiating resuscitation and&#47;or mechanical ventilation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Data used for calculating the ISS were prospectively collected by the intensivist in charge of the patient after ICU admission&#44; based on the Abbreviated Injury Scale &#40;updated in 2008&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Quantitative data are reported as means &#40;standard deviation&#41; &#40;SD&#41; and qualitative data as absolute frequencies and percentages&#46; Probability of survival was calculated according to TRISS methodology<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a> and secondarily&#44; predicted mortality was calculated as follows&#58; &#40;100 &#8211; predicted probability of survival&#41;&#46; To evaluate the validity of the model&#44; we studied discrimination and calibration in the whole sample and distributed according to blunt or penetrating mechanisms of injury&#46; Discrimination refers to the ability to distinguish between patients who die and those that survive&#46; Accordingly&#44; if the model predicts a mortality rate of 20&#37;&#44; discrimination is perfect if the observed mortality is 20&#37;&#46; It can be evaluated using receiver operating characteristic &#40;ROC&#41; curves and the area under the curves &#40;AUCs&#41; &#40;95&#37; confidence interval&#44; 95&#37; CI&#41;&#46; The greater the area&#44; the better the discrimination&#46; Sensitivity &#40;S&#41;&#44; specificity &#40;Sp&#41;&#44; and the positive &#40;PPV&#41; and negative predictive values &#40;NPV&#41; were recorded in each case&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The calibration of a prognostic model evaluates the concordance between the probability observed in the sample and the probability predicted by the model&#44; describing how the prognostic scale works over wide ranges of predicted mortality&#46; It is evaluated using the Hosmer&#8211;Lemeshow &#40;HL&#41; goodness-of-fit test&#44; in patients with low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#8211;50&#37;&#41; and high predicted mortality rates &#40;&#62;50&#37;&#41;&#46; A probability of close to 1 represents better adjustment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The SPSS<span class="elsevierStyleSup">&#174;</span> version 20 statistical package &#40;IBM Corporation 2011&#41; was used throughout&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 2242 patients formed the global cohort of the pilot phase of the RETRAUCI&#46; Patient dropout from the sample was due to different reasons&#44; the most important being inability to determine hospital outcome in 21&#46;1&#37; of the cases&#44; due to patient transfer to the corresponding reference hospital&#46; In most cases&#44; transfer was done to another country&#44; making follow-up impossible&#46; The flowchart in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> summarizes the final sample of 1405 patients included in the study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The mean patient age was 46&#46;7 &#40;19&#46;4&#41; years&#44; and 80&#46;3&#37; were males&#46; The mean ISS score was 21&#46;3 &#40;12&#46;1&#41;&#46; A total of 1305 patients suffered blunt trauma &#40;92&#46;9&#37;&#41; as the main mechanism of injury&#44; while the remaining 100 patients &#40;7&#46;1&#37;&#41; presented penetrating trauma&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the data referred to patient epidemiology&#44; acute management&#44; resource utilization and main outcome&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The observed mortality rate &#40;including ICU and post-ICU stay&#41; was 18&#37; &#40;253 patients&#41;&#44; with a predicted mortality rate of 16&#46;9&#37;&#46; In patients with blunt trauma&#44; the observed and predicted mortality rates were 18&#46;5&#37; and 17&#46;1&#37;&#44; respectively&#46; In penetrating trauma&#44; the observed and predicted mortality rates were 12&#37; and 14&#46;2&#37;&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution of patients who died in groups with low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#8211;50&#37;&#41; and high predicted mortality &#40;&#62;50&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The global sample of 1405 patients presented an area under the ROC curve of 0&#46;889 &#40;95&#37; CI&#58; 0&#46;867&#8211;0&#46;911&#41;&#44; with S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#46;9&#37;&#44; Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#46;2&#37;&#44; PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#46;6&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#46;9&#37;&#46; Patients with blunt trauma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; presented an area under the ROC curve of 0&#46;887 &#40;95&#37; CI&#58; 0&#46;864&#8211;0&#46;910&#41;&#44; with S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#46;6&#37;&#44; Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>96&#46;2&#37;&#44; PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#46;3&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>89&#46;6&#37;&#44; while patients with penetrating trauma &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; presented an area under the ROC curve of 0&#46;919 &#40;95&#37; CI&#58; 0&#46;859&#8211;0&#46;979&#41;&#44; with S<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#46;3&#37;&#44; Sp<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#46;5&#37;&#44; PPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#46;6&#37; and NPV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>94&#46;4&#37;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The results of the Hosmer&#8211;Lemeshow &#40;HL&#41; goodness-of-fit test&#44; in both in the total cohorts of patients of patients and distributed according to the mechanism of trauma &#40;blunt or penetrating&#41; are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; The correlation between predicted and observed mortality is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Our study shows that TRISS methodology applied in the sample of patients included in the pilot phase of the RETRAUCI presented good levels of discrimination with inadequate calibration&#44; especially in patients with blunt trauma&#46; Penetrating trauma showed better discrimination and good calibration&#46; Altogether&#44; these results suggest that newly calibrated &#40;<span class="elsevierStyleItalic">b</span> coefficient&#41; scales are necessary in our setting&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Our sample of patients offers an initial picture of patients with severe trauma admitted to the ICUs of our setting&#44; taking into account the severity of injury&#44; the care provided&#44; length of stay and mortality&#46; These Units represent level I and II centers&#46; Such patients usually present high ISS values&#44; important resource utilization&#44; and high mortality&#46; The TRISS methodology is based on the degree of anatomical injury &#40;ISS&#41;&#44; physiological response &#40;RTS&#41; and functional reserve &#40;age&#41;&#46; It was first developed in the 1980s through several logistic regression models<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;9</span></a> with different b coefficients considering blunt or penetrating injuries&#46; Several updates have been made since then&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">When applied to our patients&#44; TRISS showed good discrimination with inadequate calibration &#8211; a fact that limits the use of this prognostic model&#46; This observation is consistent with other studies&#44; and in general&#44; with other prognostic scores in the ICU setting&#44; where the main shortcoming corresponds to inadequate calibration despite good discrimination&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It must be noted that in our sample of patients&#44; those with penetrating injury showed good calibration&#46; This fact is consistent with previous studies differentiating between blunt and penetrating trauma&#46; In the latter type of trauma&#44; discrimination and calibration is better&#44; perhaps due to lesser improvement in their specific care&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Poor calibration and discrimination does not necessarily refer to the quality of the care provided but rather to incorrect application of the model to a population with specific characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In addition&#44; TRISS is considered to present lower sensitivity for blunt trauma&#44; since it underestimates brain injury&#59; does not consider multiple injuries in the same anatomical area&#59; and does not consider age on an individual basis&#46; In our sample of patients&#44; on taking into account the different mortality groups&#44; TRISS underestimated mortality when the predicted mortality was &#60;60&#37; and overestimated it when the predicted mortality was &#62;60&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Mortality prediction according to TRISS has therefore been questioned<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#58; its clinical application has shown opposite results&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> especially when used in non-MTOS patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> The best way to increase its predictive value is to use local correction factors to adjust for <span class="elsevierStyleItalic">b</span> coefficients&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> The results of our study confirm that newly developed b coefficients are needed for trauma patients admitted to Spanish ICUs&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">New scores have been developed in an attempt to improve the predictive value of TRISS&#46; Some of them are the ASCOT &#40;A Severity Characterization Of Trauma&#41;&#44; which includes gender&#44; 5 age categories and different anatomic scales&#59; the ICISS &#40;International Classification of Diseases Ninth revision based injury severity score&#41;&#59; the NISS &#40;New Injury Severity Score&#41;&#59; the RISC &#40;Revised Injury Severity Classification score&#41;&#59; or the pediatric BIG score&#46; However&#44; although they have slightly improved the predictive ability of TRISS methodology&#44; the latter remains the most widely used tool in clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;20&#44;23&#8211;25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study has a number of limitations &#8211; some attributable to the TRISS model itself&#44; and other specific of our sample&#46; The most relevant are &#40;a&#41; the limited number of patients for this kind of analysis despite the multicenter nature of the study&#46; This corresponds to the pilot phase of the RETRAUCI&#46; With a growing number of centers recruiting patients&#44; we expect to solve this issue in the future&#59; &#40;b&#41; up to 21&#37; of the patients were lost for hospital outcome evaluation&#46; This was due to the large number of patients from different countries that are admitted to our ICUs and are subsequently transferred to their reference hospitals at home&#44; thereby making follow-up impossible&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In sum&#44; TRISS methodology in the Spanish RETRAUCI showed good levels of discrimination&#44; with inadequate calibration&#44; especially in blunt trauma&#46; Penetrating trauma showed better discrimination and good calibration&#46; Altogether&#44; these results suggest that newly calibrated &#40;<span class="elsevierStyleItalic">b</span> coefficient&#41; scales are necessary in our setting&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Collaborators</span><p id="par0140" class="elsevierStylePara elsevierViewall">Carlos Garc&#237;a-Fuentes&#44; Luis Terceros-Almanza &#40;Hospital Universitario 12 Octubre&#41;&#44; Iker Garc&#237;a-S&#225;ez&#44; Ruth Salaberria-Udabe &#40;Hospital Universitario de Donostia&#41;&#44; Cecilia Carbayo-G&#243;rriz &#40;Complejo Hospitalario de Torrec&#225;rdenas&#41;&#44; Carmen Corcobado-M&#225;rquez &#40;Hospital General Universitario de Ciudad Real&#41;&#44; Javier Trujillano-Cabello &#40;Hospital Universitari Arnau de Vilanova&#41;&#44; Eduardo Mi&#241;ambres-Garc&#237;a &#40;Hospital Universitario Marqu&#233;s de Valdecilla&#41;&#44; Amanda Lesmes-Gonz&#225;lez &#40;Hospital Universitario de Getafe&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">RETRAUCI received funding from the <span class="elsevierStyleGrantSponsor" id="gs1"><span class="elsevierStyleItalic">Fundaci&#243;n Mutua Madrile&#241;a</span></span> during three years for the development of a web-based database&#44; granted to the principal investigator &#40;Dr&#46; Chico-Fern&#225;ndez&#44; <span class="elsevierStyleGrantNumber" refid="gs1">AP117892013</span>&#41;&#44; on behalf of the Trauma and Neurointensive Care Working Group of the SEMICYUC&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">All authors listed in the study declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To validate <span class="elsevierStyleItalic">Trauma and Injury Severity Score &#40;TRISS&#41;</span> methodology as an auditing tool in the Spanish ICU Trauma Registry &#40;RETRAUCI&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; multicenter registry evaluation was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thirteen Spanish Intensive Care Units &#40;ICUs&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Individuals with traumatic disease and available data admitted to the participating ICUs&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015&#46; Discrimination was evaluated using receiver operating characteristic &#40;ROC&#41; curves and the corresponding areas under the curves &#40;AUCs&#41; &#40;95&#37; CI&#41;&#44; with calibration using the Hosmer&#8211;Lemeshow &#40;HL&#41; goodness-of-fit test&#46; A value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered significant&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Predicted and observed mortality&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1405 patients were analyzed&#46; The observed mortality rate was 18&#37; &#40;253 patients&#41;&#44; while the predicted mortality rate was 16&#46;9&#37;&#46; The area under the ROC curve was 0&#46;889 &#40;95&#37; CI&#58; 0&#46;867&#8211;0&#46;911&#41;&#46; Patients with blunt trauma &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1305&#41; had an area under the ROC curve of 0&#46;887 &#40;95&#37; CI&#58; 0&#46;864&#8211;0&#46;910&#41;&#44; and those with penetrating trauma &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41; presented an area under the curve of 0&#46;919 &#40;95&#37; CI&#58; 0&#46;859&#8211;0&#46;979&#41;&#46; In the global sample&#44; the HL test yielded a value of 25&#46;38 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#58; 27&#46;35 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; in blunt trauma and 5&#46;91 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;658&#41; in penetrating trauma&#46; TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination&#44; with inadequate calibration &#8211; particularly in blunt trauma&#46;</p></span>"
        "secciones" => array:8 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
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            "titulo" => "Setting"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar el <span class="elsevierStyleItalic">Trauma and Injury Severity Score</span> &#40;TRISS&#41; como instrumento de auditor&#237;a en el Registro Espa&#241;ol de Trauma en UCI&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Evaluaci&#243;n prospectiva de un registro multic&#233;ntrico&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Trece UCI espa&#241;olas&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Individuos con enfermedad traum&#225;tica y datos completos ingresados en las UCI participantes&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparamos la mortalidad predicha por el TRISS con la observada en la fase piloto del Registro Espa&#241;ol de Trauma en UCI desde noviembre de 2012 hasta enero de 2015&#46; La discriminaci&#243;n se evalu&#243; mediante curvas <span class="elsevierStyleItalic">receiver operating characteristic</span> y el valor bajo su &#225;rea &#40;IC 95&#37;&#41;&#44; y la calibraci&#243;n&#44; mediante el test de bondad de ajuste de Hosmer-Lemeshow&#46; Un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 se consider&#243; significativo&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Principales variables de inter&#233;s</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Mortalidad observada y predicha&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Analizamos 1&#46;405 pacientes&#46; La mortalidad observada fue del 18&#37; &#40;253 pacientes&#41;&#44; mientras que la predicha fue del 16&#44;9&#37;&#46; El &#225;rea bajo la curva <span class="elsevierStyleItalic">receiver operating characteristic</span> fue de 0&#44;889 &#40;IC 95&#37; 0&#44;867-0&#44;911&#41;&#46; Los pacientes con trauma cerrado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;305&#41; presentaron un &#225;rea bajo la curva <span class="elsevierStyleItalic">receiver operating characteristic</span> de 0&#44;887 &#40;IC 95&#37; 0&#44;864-0&#44;910&#41;&#44; y aquellos con traumatismo penetrante &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#44; de 0&#44;919 &#40;IC 95&#37; 0&#44;859-0&#44;979&#41;&#46; En la muestra global&#44; el test de Hosmer-Lemeshow mostr&#243; un valor de 25&#44;38 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; siendo de 27&#44;35 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; en trauma cerrado y de 5&#44;91 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;658&#41; en trauma penetrante&#46; La metodolog&#237;a TRISS infraestim&#243; la mortalidad en los pacientes con mortalidad predicha baja y la sobreestim&#243; en pacientes con mortalidad predicha elevada&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La aplicaci&#243;n de la metodolog&#237;a TRISS en el trauma grave ingresado en las UCI espa&#241;olas mostr&#243; buenos niveles de discriminaci&#243;n y una calibraci&#243;n inadecuada&#44; especialmente en el traumatismo cerrado&#46;</p></span>"
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            "titulo" => "Dise&#241;o"
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            "identificador" => "abst0055"
            "titulo" => "&#193;mbito"
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            "identificador" => "abst0060"
            "titulo" => "Pacientes"
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            "titulo" => "Intervenciones"
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          5 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Principales variables de inter&#233;s"
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            "identificador" => "abst0075"
            "titulo" => "Resultados"
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            "identificador" => "abst0080"
            "titulo" => "Conclusiones"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">RTA&#44; road traffic accident&#59; ISS&#44; Injury Severity Score&#59; ICP&#44; Intracranial pressure&#59; MOF&#44; Multiorgan failure&#59; ICU&#44; Intensive Care Unit&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1405&#41;<br>Number &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma mechanism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">571 &#40;40&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">394 &#40;28&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aggression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Occupational accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Self-injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sports-related&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;5&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;4&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Out-of-hospital medical support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1240 &#40;88&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ISS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">429 &#40;30&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#8211;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">600 &#40;42&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#8211;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">342 &#40;24&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemodynamically stable-admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">878 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICP monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">233 &#40;18&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood transfusion 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">351 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">806 &#40;66&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanical ventilation &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;7 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MOF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-ICU stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Global mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1390392.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Epidemiological and clinical data of the 1405 patients included in the study&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients<br><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dead<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&#8211;9&#46;99&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">916&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;4&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&#8211;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">316&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;27&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#62;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;74&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1390393.png"
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            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients who died in the groups with low &#40;&#60;10&#37;&#41;&#44; intermediate &#40;10&#8211;50&#37;&#41; and high predicted mortality &#40;&#62;50&#37;&#41;&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>number of patients&#59; df&#44; degrees of freedom&#59; H-L&#44; Hosmer&#8211;Lemeshow goodness-of-fit test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted mortality deciles &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observed survivors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted survivors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Observed dead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predicted dead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">H&#8211;L<br>df<br><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Total sample &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1405&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;9&#8211;1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46;3&#8211;2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">149&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46;3&#8211;3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46;6&#8211;5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#46;8&#8211;9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>9&#46;2&#8211;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>15&#46;1&#8211;31&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;38<br>8<br>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>31&#46;8&#8211;63&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>63&#46;7&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Blunt trauma &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1305&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;3&#8211;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;8&#8211;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46;1&#8211;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;35<br>8<br>&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>63&#46;3&#8211;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;8&#8211;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#8211;1&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleHsp" style=""></span>7&#46;1&#8211;31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "The value of trauma registries"
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                          "autores" => array:2 [
                            0 => "L&#46; Moore"
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                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2008.02.023"
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                        "tituloSerie" => "Injury"
                        "fecha" => "2008"
                        "volumen" => "39"
                        "paginaInicial" => "686"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18511052"
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                      "titulo" => "Trauma registries&#58; a health priority&#44; a strategic project for the SEMICYUC"
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                          "etal" => false
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        "texto" => "<p id="par0155" class="elsevierStylePara elsevierViewall">The authors are indebted to Vicente G&#243;mez-Tello &#40;Hospital Moncloa&#44; Madrid&#46; Working Groups Coordinator&#44; SEMICYUC&#41;&#44; Andr&#233;s J&#46; Chac&#243;n &#40;Project Manager&#44; Xferic&#41; and Miguel Ferrero-Fern&#225;ndez &#40;Department of Informatics&#44; SEMICYUC&#41; for their invaluable help in developing the registry and the web-based tool&#46;</p>"
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Article information
ISSN: 21735727
Original language: English
DOI:10.1016/j.medine.2016.09.001
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