Original Contribution
Comparison of the Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II scoring system, and Trauma and Injury Severity Score method for predicting the outcomes of intensive care unit trauma patients

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Abstract

Purpose

The aim of this study was to assess the ability of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, and Trauma and Injury Severity Score (TRISS) method to predict group mortality for intensive care unit (ICU) trauma patients.

Methods

The medical records of 706 consecutive major trauma patients admitted to the ICU of Samsung Changwon Hospital from May 2006 to April 2010 were retrospectively examined. The SOFA and the APACHE II scores were calculated based on data from the first 24 hours of ICU admission, and the TRISS was calculated using initial laboratory data from the emergency department and operative data. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and TRISS equations. The ability to predict group mortality for the SOFA score, APACHE II score, and TRISS method was assessed by using 2-by-2 decision matrices and receiver operating characteristic curve analysis and calibration analysis.

Results

In 2-by-2 decision matrices with a decision criterion of 0.5, the sensitivities, specificities, and accuracies were 74.1%, 97.1%, and 92.4%, respectively, for the SOFA score; 58.5%, 99.6%, and 91.1%, respectively, for the APACHE II scoring system; and 52.4%, 94.8%, and 86.0%, respectively, for the TRISS method. In the receiver operating characteristic curve analysis, the areas under the curve for the SOFA score, APACHE II scoring system, and TRISS method were 0.953, 0.950, and 0.922, respectively.

Conclusion

The results from the present study showed that the SOFA score was not different from APACHE II scoring system and TRISS in predicting the outcomes for ICU trauma patients. However, the method for calculating SOFA scores is easier and simpler than APACHE II and TRISS.

Introduction

Illness severity scoring systems have become important tools for studying patient outcomes. Early efforts to measure the efficacy of trauma centers and trauma systems assessed the rates of preventable mortality. With increasing incidence of trauma, a multitude of statistical models has been developed in an attempt to accurately predict outcomes for trauma patients. Instruments for scoring illness severity, such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and III or the Simplified Acute Physiology Score II, are widely used for critically ill patients. More recently, the Sequential Organ Failure Assessment (SOFA) scoring system was developed and validated.

Trauma scoring systems were initially developed to triage patients in the field and needed to be straightforward and user friendly. There are several systems such as the triage Revised Trauma Score, Triage Score, and Trauma and Injury Severity Score (TRISS) for predicting the severity of trauma patients' conditions along with patient outcomes. The Major Trauma Outcome Study and TRISS methodology were a major advance toward establishing an objective measurement of trauma center care with stratification according to the magnitude of patients' injuries [1], [2]. However, there are few methods for precisely and easily predicting the outcomes of intensive care unit (ICU) trauma patients. The purpose of this study was to assess the ability of the SOFA score, APACHE II scoring system, and TRISS method to predict group mortality among ICU trauma patients.

Section snippets

Study design

This was a retrospective cohort study conducted from May 2006 to April 2010.

Study setting

This study was conducted at a regional emergency center affiliated with an academic university hospital in Changwon, South Korea.

Ethics with study approval

A retrospective chart review was performed after this study was received institutional review board approval from the Samsung Changwon Hospital, Sungkyunkwan University School of Medicine; the consent form was exempted.

Data collection

The medical records of 796 consecutive ICU trauma patients admitted to the

Results

Of the 706 trauma patients enrolled in the study, blunt trauma was the reason for 94.8% of the ICU admissions. The overall survival rate was 79.2%. Table 1 shows the variables that were found to be significantly different between the survivor and nonsurvivor groups. Compared with the nonsurvivors, survivors were generally younger patients (mean, 44.2 vs 50.1 years; P < .001), had a higher O2 index (308.0 ± 109.8 vs 237.2 ± 138.6; P < .001), and had higher systolic blood pressure and GCS scale (

Discussion

Regardless of the number of patients studied, prognostic estimates are still only estimates. Providing intensive medical care to individuals will always require experienced clinical judgment and careful integration of objective data with other relevant information such as an individual's reaction to treatment and the personal wishes of the patient. Given the high patient mortality rates and long-term reimbursement shortfalls of trauma centers, it is important that trauma care providers continue

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