ACCURACY OF TRISS METHOD IN DETERMINING SURVIVAL PATIENTS WITH MULTIPLE TRAUMA IN

DR.WAHIDIN SUDIROHUSODO HOSPITAL MAKASSAR.

Nuralim Mallapasi

Thoracic Cardiac and Vascular Dept Faculty Of Medicine Hasanuddin Univ

Makassar South Sulawesi Indonesia

Background

advances in technology and human civilization,

the higher mobility of individuals,

the risk of traffic accidents and workplace accidents such as trauma

violence between individuals or citizens

Talwar S, about 3.3 million people per year due to traffic accidents and 48,000 people died.

1986 in Indonesia 2.5 million people suffered from trauma and 10000 died from traffic accidents.

1992 Indonesia: Health Survey household Trauma

out of 15-24 age group is the first order;

age group 25-45 years old ranked as second;

majority of trauma patients are productive age group

of 15-45 years old

in some developed countries have developed an

assessment of trauma system ;

trauma score is a system used to assess the

anatomical and physiological damage

currently the most widely used is the combined scoring of

anatomical and physiological scoring

TRISS (Trauma Score and Injury Severity score) and ASCOT

methods (a characterization on trauma severity)

TRISS method using AIS score (abreviated Injury Scale) as

an anatomic score, then calculated to be ISS (injury severity

scale);

physiological scoring on TRISS method is RTS (revised

trauma score)

This study used the TRISS method to assess the probability

of survival

Trauma Score System

Anatomical score

Abbreviated Injury Scale (AIS)

Injury Severity Score (ISS)

Physiological Score

Glasgow Coma Scale (GCS)

Revised Trauma Score (RTS)

Combination of both

Pediatric Trauma Score

Trauma Score and Injury Severity Score (TRISS)

TRAUMA SCORE AND INJURY SEVERITY SCORE

TRISS is a combination of physiological and

anatomical trauma score (RTS + ISS)

TRISS assess the likelihood survival of patients

TRISS assessment is done by combining RTS,

ISS, patient age and whether the mechanism of

blunt or penetrating trauma to determine

PROBABILITY OF SURVIVAL =PS

TRISS using the formula:

PS=1 / ( 1+e )

b = 0,5600+0,7281 (RTS) – 0,1132 (ISS) + (-0,8339) (age)

e = equivalent with 2,7182

Age : < 55 YO = 0 > 55 YO = 1

b0 - b3 is coofisient obtained from regression analysis on a data set of trauma network

TRISS is important to understand that only a mathematical calculation rather than an absolute measure in assessing life expectancy

-b

case

65-year-old pedestrian was hit by falling and suffering a head injury, abdominal and lower leg.

On examination GCS 9, breathing 35 times per minute, blood pressure of 80 mmHg systolic,

CT scan of the head showed a small subdural hematome with swelling in the left parietal lobe

there is a large liver laceration but no other intra-abdominal trauma.

Radiological: showed the lower limbs dislocated and fractured in both proximal tibia

RTS

GCS = 9 ; code value of 3 X 0.9368 = 2.8104

Respiratory rate = 35 code value of 3 X 0.7326 =

2.1978

Total RTS = 5.8806

RTS value of 5.8806 means that the general

state of the patient is critical.

ISS

Components AIS

small subdural hematoma; 4

swelling in the left parietal lobe; 3

extensive liver laceration; 4

tibia fracture / dislocation 3

ISS = 4 + 4 + 3 = 41

ISS value of 41 obtained from 2 severe injuries and 1 critical injury means an injury sustained is severe

2 2 2

PROBABILITY OF SURVIVAL = PS

Coefficient SOURCE OF DATA BLUNT TRAUMA

from TRAUMA NETWORK is:

b0 = 0,5600

b1 = 0,7281

b2 = - 0,1132

b3 = 0,8339

b= 0,56+(0,7281)(5,8806)+(-0,1132)941)+(-

0,8339)(1)

PS = 1/(1 + e ) = 0,1634 = 16 %

PS value of 16% means survival rate is also 16%

TRISS method;

when PS is more than 0.5 , the patient survival is expressed as EXPECTED SURVIVAL and

if the patient died, it is indicated as TREATMENT FAILURE.

when PS is less than or equal to 0.5, and the patient died, it is expressed as EXPECTED DEATH

if the person lives it is declared as the SUCCESS OF THERAPY.

-b

MATERIALS AND METHODS

the accuracy of TRISS method as

diagnostic test in determining life

expectancy in multiple trauma from

December 2012 to May 2013,

100 patients were counted by using

TRISS Methods which consist of

RTS, ISS and PS

DATA ANALYSIS

Based on TRISS methods The Data was analyzed by using

SPSS software to calculate the sensitivity, specificity and accuracy in determining the possibility of life expectancy

It also calculated the magnitude of therapeutic failure and therapeutic success by using the formula

OUTCOME

Live Die Total

PS Live (>50%) a b a+b

Die (<50%) c d c+d

Total a+c b+d a+b+c+d

Sensitivity = X 100%

Specificity = X 100%

Accuracy = X 100%

a

a + c

d

b + d

(a + d)

a + b + c + d

Positive predictive value = X 100%

EXPECTED SURVIVAL

Negative predictive value = X 100%

expected dead

Therapeutic failure = X 100%

Therapeutic success = X 100%

a

a + b

d

c + d

b

a + b

c

c + d

RESULTS AND DISCUSSION

patients aged between 1.0 to 69.0 years old,

with a mean of 30.8 years old, generally aged

16-45 years old (68%),

men (88%) are more than women (22%)

The cause of trauma generally due to traffic

accidents by 69.0%, mostly caused by blunt

trauma (thoracic and abdominal, pelvic fracture,

perineal trauma ) and head trauma (86.0%) is

the leading cause of death in this study

From the characteristics analyzed, the patient

outcomes is found to be no significant difference

(p> 0.05) based on patient characteristics

consisting of age, sex, type of trauma and the

cause of trauma

There is no significant difference in outcome (p>

0.05) based on the type and speed of action.

The life expectancy is analyzed by the TRISS method for the patient outcome.

It is predicted the patient lives when PS > 0.5, and the patient dies when PS < 0.5.

Three of the patients had PS < 0.5 and all of them were died.

97 multiple trauma patients have PS > 0.5 and 9 of them died,

meaning that therapeutic failure was found in 9 from the 97 patients (9.3%)

Outcome

Predictions of

life expectancy

Live

N (%)

Die

N (%)

Total

N (%)

PS > 0.5 (live) 88 (90.7%)

(100.0%)

9 (9.3%)

(75%)

97 (100%)

(97.0)

PS < 0.5 (die) 0 (0.0%)

(0.0%)

3 (100%)

(25.0%)

3 (100.0%)

(3.0%)

TOTAL 88 (88.0%)

(100.0%)

12 (12.0%)

(100.0%)

100 (100.0%)

(100.0%)

Primary data.

Generally be calculated sensitivity 88.0%,

Specificity of 25.0%,

Accuracy of 91.0%,

Expected survival of 90.7%;

Death expected value of 100%;

Therapeutic failure of 9.3%

and 0.0% of therapeutic success.

CONCLUSIONS:

the results of this study indicate that the TRISS method has accuracy, sensitivity, expected survival and expected death is quite high, but lack of specificity.

TRISS method is more accurate in predicting death than possibility of alive

TRISS method should be used for the prediction of outcome in multiple trauma patients at each hospital to help doctors and medical staff in order to make a more precise prognostic in each multiple trauma patients

Thank you