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Vol. 44. Issue 6.
Pages 325-332 (August - September 2020)
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Vol. 44. Issue 6.
Pages 325-332 (August - September 2020)
Original
DOI: 10.1016/j.medine.2020.05.002
Evaluation of quality of care in trauma patients using international scoring systems
Valoración de la calidad asistencial al traumatismo grave mediante comparación con estándares internacionales
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J. Sainz Cabrejasa,
Corresponding author
jvsc89@gmail.com

Corresponding author.
, C. García Fuentesa, C. García Juarranzb, A.M. González Lópezb, L. Maure Blesab, J.C. Montejo Gonzáleza, M. Chico Fernándeza
a Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
b Universidad Complutense de Madrid, Madrid, Spain
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Table 1. Subgroup analysis of age, type of trauma, damage to anatomical region, and injury severity score (ISS) for the updated TRISS and PS14 models.
Abstract
Objective

To evaluate the ability of the TRISS and PS14 models to predict mortality rates in our medical system and population.

Design

A retrospective observational study was carried out over a 66-month period.

Background

The study was conducted in the Trauma Intensive Care Unit (ICU) of a third level hospital.

Patients

All severe trauma patients (Injury Severity Score16 and/or Revised Trauma Score<12) aged >14 years were included.

Variables of interest

Medical care data were prospectively recorded. The “W” statistic (difference between expected and observed mortality for every 100 patients) and its significance were calculated for each model. Discrimination and calibration were evaluated by means of receiver operating characteristic (ROC) curves, and the Hosmer–Lemeshow test and GiViTI calibration belt, respectively.

Results

A total of 1240 patients were included. Survival at hospital discharge was 81.9%. The “W” scores for the TRISS, TRISS 2010 and PS14 models were +6.72 (P<.01), +1.48 (P=.08) and +2.74 (P<.01) respectively. Subgroup analysis revealed significant favorable results for some populations. The areas under the ROC curve for the TRISS, TRISS 2010 and PS14 models were 0.915, 0.919 and 0.914, respectively. There were no significant differences among them (P>.05). Both the Hosmer–Lemeshow test and GiViTI calibration belt demonstrated poor calibration for the three models.

Conclusions

These models are suitable tools for assessing quality of care in a Trauma ICU, affording excellent discrimination but poor calibration. In our institution, survival rates higher than expected were observed.

Keywords:
Major trauma
TRISS
PS14
Quality of health care
Resumen
Objetivo

Evaluar la capacidad de los modelos TRISS y PS14 para predecir la probabilidad de supervivencia en nuestro sistema de salud y población.

Diseño

Desarrollamos un estudio observacional retrospectivo durante un periodo de 66 meses.

Ámbito

El estudio se llevó a cabo en una UCI especializada en traumatología en un hospital urbano de alta complejidad.

Pacientes

Se incluyeron en el estudio los pacientes mayores de 14 años con traumatismo grave (definido como ISS16 y/o RTS<12).

Variables de interés

Se calculó el estadístico W (diferencia entre la mortalidad—hospitalaria o a los 30 días para los modelos TRISS o PS14 respectivamente—calculada y observada por cada 100 pacientes) y su nivel de significación para cada modelo. Se realizó un análisis por subgrupos. La calibración y discriminación se evaluaron por medio del test de Hosmer-Lemeshoy y cinturón GiViTI y curvas ROC respectivamente.

Resultados

Se incluyeron 1.240 pacientes. La supervivencia global al alta fue de 81,9%. El estadístico W para los modelos TRISS, TRISS2010 y PS14 fue respectivamente +6,72 (p<0,01), +1,48 (p=0,08) y +2,74 (p<0,01). El AUROC para los citados modelos fue respectivamente 0,915, 0,919 y 0,914, sin que se encontraran diferencias significativas entre ellos. Tanto el test de Hosmer-Lemeshow como el cinturón de calibración GiViTI mostraron escasa calibración en los 3 modelos.

Conclusiones

Estos modelos son una herramienta adecuada para la evaluación de la calidad asistencial en una UCI de traumatismo. En nuestro centro las tasas de supervivencia fueron mayores de lo predicho por los modelos.

Palabras clave:
Traumatismo grave
TRISS
PS14
Calidad asistencial

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