External Validation of the Trauma Injury Severity Score (TRISS) in Patients with Major Injuries at a Tertiary Care Public Hospital in Thailand
TRISS Validation in Major Trauma Patients in Thailand
Keywords:
TRISS, Major trauma, External validation, Prediction modelAbstract
Objective: To externally validate TRISS's probability of survival in a tertiary care hospital in northeastern Thailand.
Materials and Methods: A retrospective cohort prognostic study included patients with significant injuries (ISS > 15) admitted to the hospital from 2011 to 2022 from the Khon Kaen trauma registry. Baseline characteristics were identified. AuROC presented the accuracy of the model. The age group was used as a subgroup analysis. The primary outcome was in-hospital mortality.
Results: This retrospective cohort study was conducted at a tertiary care public hospital in northeastern Thailand. A total of 20,867 patients were included. Missing primary outcome data were excluded. Most patients were male (75.23%). The mean age was 38.19 ± 19.65 years. The mean ISS was 20.17 ± 5.28. The mortality rate was 15.33%. AuROC was 0.8388. Subgroup analysis by age group showed a statistically significant reduction in AuROC by increasing age.
Conclusion: The accuracy of the TRISS model in a tertiary care hospital in Thailand was excellent, as close as MTOS. The accuracy was decreased by age. The TRISS model is applied to trauma quality improvement programs in Thailand.
References
FastStats. Leading Causes of Death; 2024 [cited 2024 March 24]. Available from: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
American College of Surgeons. Trauma Quality Improvement Program (TQIP); 1996-2024. [cited 2024 March 24]. Available from: https://www.facs.org/quality-programs/trauma/quality/trauma-quality-improvement-program/
Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27(4):370-8.
Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990;30(11):1356-65.
Hadisaputra IH, Suwedagatha G, Mahadewa TG. Adjustment of Trauma and Injury Severity Sccore (TRISS) and Revised Trauma Score (RTS) in Predicting Mortality of Multitraumapatients in Sanglah Hospital Bali. Biomed Pharmacol J. 2021;14(1):267-72. doi: 10.13005/bpj/2122.
Hariharan S, Chen D, Parker K, et al. Evaluation of trauma care applying TRISS methodology in a Caribbean developing country. J Emerg Med. 2009;37(1):85-90. doi: 10.1016/j.jemermed.2007.09.051.
Driessen MLS, van Klaveren D, de Jongh MAC, et al. Modification of the TRISS: simple and practical mortality prediction after trauma in an all-inclusive registry. Eur J Trauma Emerg Surg. 2022;48(5):3949-59. doi: 10.1007/s00068-022-01913-2.
Domingues CA, Coimbra R, Poggetti RS, et al. Performance of new adjustments to the TRISS equation model in developed and developing countries. World J Emerg Surg. 2017;12:17. doi: 10.1186/s13017-017-0129-2.
Roy N, Gerdin M, Schneider E, et al. Validation of international trauma scoring systems in urban trauma centres in India. Injury. 2016;47(11):2459-64. doi: 10.1016/j.injury.2016.09.027.
Tan JH, Tan HCL, Noh NAM, et al. Validation of the trauma mortality prediction scores from a Malaysian population. Burns Trauma. 2017;5:37. doi: 10.1186/s41038-017-0102-z.
Kaza VK, Nathan B. Validity of Trauma and Injury Severity Score Scoring in India. J Emerg Trauma Shock. 2023;16(1):30-31. doi: 10.4103/jets.jets_120_22.
World Health Organization. Global status report on road safety 2023; 2023. [cited 2024 March 24]. Available from: https://www.who.int/publications-detail-redirect/9789240086517.
Van Ditshuizen JC, Sewalt CA, Palmer CS, et al. The definition of major trauma using different revisions of the abbreviated injury scale. Scand J Trauma Resusc Emerg Med. 2021;29(1):71. doi: 10.1186/s13049-021-00873-7.
Feliciano DV, Mattox KL, Moore EE. Trauma, Ninth Edition. 9th Edition. New York: McGraw Hill / Medical, 2020:1440.
Podang J, Singhasivanon P, Podhipak A, et al. Primary verification: is the TRISS appropriate for Thailand? Southeast Asian J Trop Med Public Health. 2004;35(1):188-94.
Scarpelini S, de Andrade JI, Dinis Costa Passos A. The TRISS method applied to the victims of traffic accidents attended at a tertiary level emergency hospital in a developing country. Injury. 2006;37(1):72-7. doi: 10.1016/j.injury.2005.06.006.
Siritongtaworn P, Opasanon S. The use of Trauma Score-Injury Severity Score (TRISS) at Siriraj Hospital: how accurate is it? J Med Assoc Thai. 2009;92(8):1016-21.
Cayten CG, Stahl WM, Murphy JG, et al. Limitations of the TRISS method for interhospital comparisons: a multihospital study. J Trauma. 1991;31(4):471-81. doi: 10.1097/00005373-199104000-00005.
The World Bank. Overview The World Bank in Thailand. [cited 2024 March 24]. Available from: https://www.worldbank.org/en/country/thailand/overview.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 The Royal College of Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
