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Title: Comparison of Intensive Care and Trauma-specific Scoring Systems in Critically Ill Patients.
Austin Authors: Magee, F;Wilson, A;Bailey, M;Pilcher, D;Gabbe, B;Bellomo, Rinaldo 
Affiliation: Royal Melbourne Hospital, Parkville, Melbourne
Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
Australian & New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
School of Public Health and Preventive Medicine, Monash University
Austin Health
Department of Medicine and Radiology, University of Melbourne, Melbourne, VIC
Alfred Hospital, Melbourne, VIC
Issue Date: Sep-2021
Date: 2021-03-26
Publication information: Injury 2021; 52(9): 2543-2550
Abstract: Amongst critically ill trauma patients admitted to ICU and still alive and in ICU after 24 hours, it is unclear which trauma scoring system offers the best performance in predicting in-hospital mortality. The Australia and New Zealand Intensive Care Society Adult Patient Database and Victorian State Trauma Registry were linked using a unique patient identification number. Six scoring systems were evaluated: the Australian and New Zealand Risk of Death (ANZROD), Acute Physiology and Chronic Health Evaluation III (APACHE III) score and associated APACHE III Risk of Death (ROD), Trauma and Injury Severity Score (TRISS), Injury Severity Score (ISS), New Injury Severity Score (NISS) and the Revised Trauma Score (RTS). Patients who were admitted to ICU for longer than 24 hours were analysed. Performance of each scoring system was assessed primarily by examining the area under the receiver operating characteristic curve (AUROC) and in addition using standardised mortality ratios, Brier score and Hosmer-Lemeshow C statistics where appropriate. Subgroup assessments were made for patients aged 65 years and older, patients between 18 and 40 years of age, major trauma centre and head injury. Overall, 5,237 major trauma patients who were still alive and in ICU after 24 hours were studied from 25 ICUs in Victoria, Australia between July 2008 and January 2018. Hospital mortality was 10.7%. ANZROD (AUROC 0.91; 95% CI 0.90-0.92), APACHE III ROD (AUROC 0.88; 95% CI 0.87-0.90), and APACHE III (AUROC 0.88; 95% CI 0.87-0.89) were the best performing tools for predicting hospital mortality. TRISS had acceptable overall performance (AUROC 0.78; 95% CI 0.76-0.80) while ISS (AUROC 0.61; 95% CI 0.59-0.64), NISS (AUROC 0.68; 95% CI 0.65-0.70) and RTS (AUROC 0.69; 95% CI 0.67-0.72) performed poorly. The performance of each scoring system was highest in younger adults and poorest in older adults. In ICU patients admitted with a trauma diagnosis and still alive and in ICU after 24 hours, ANZROD and APACHE III had a superior performance when compared with traditional trauma-specific scoring systems in predicting hospital mortality. This was observed both overall and in each of the subgroup analyses. The anatomical scoring systems all performed poorly in the ICU population of Victoria, Australia.
DOI: 10.1016/j.injury.2021.03.049
Journal: Injury
PubMed URL: 33827776
Type: Journal Article
Subjects: ANZROD
Critical Care
intensive care
scoring systems
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