Automated severity scoring in level I trauma patients.
The authors evaluated the sensitivity and specificity of a computerized Simplified Acute Physiology Score (SAPS) for outcome prediction in Level I trauma patients admitted to a Surgical ICU (SICU). SAPS was compared with the combined Trauma Score (TS) and Injury Severity Score (ISS). 1434 consecutive trauma patients admitted to the SICU over a 3-year period were studied. All patients had the SAPS automatically calculated on the first SICU day. Patient data was extracted from an electronic flowsheet, and the most abnormal values for the previous 24 hours were used to calculate the SAPS. TS and ISS were calculated by a trained nurse. The relationship among the severity scores, ICU length of stay (LOS), and survival was evaluated. A logistic regression equation was calculated for SAPS alone and for TS combined with ISS. The predictive power of the severity methods was compared using Receiver Operating Characteristic (ROC) curve analysis. Scores for survivors and non-survivors were compared with Student's t-tests. 1085 patients had complete data available. There were 995 survivors and 90 non-survivors. The mean (+/- standard error of the mean) ISS was 12.7 (+/- 3.2) with 36 per cent of the patients having an ISS > or = 15. The mean SAPS was 8.1 (+/- 2.5). Survivors had a significantly lower SAPS than non-survivors, 7.0 versus 20.2 (P < 0.0005) and a shorter LOS, 2.5 versus 4.9 days (P < 0.002). ROC curve analysis revealed no statistically significant difference in the areas under the two curves, indicating that the SAPS was equivalent to TS combined with ISS in outcome prediction (P > 0.70).(ABSTRACT TRUNCATED AT 250 WORDS)
Kearney
T J
TJ
Cedars-Sinai Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Shabot
M M
MM
D003422:Critical Care; D003658:Decision Making, Computer-Assisted; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015996:Survival Rate; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality*