Improving risk adjustment in critically ill trauma patients: the TRISS-SAPS Score.
OBJECTIVE
To test (a) the prognostic performance of TRISS and SAPS II scoring systems in a large sample of trauma patients admitted to Austrian ICUs, and (b) the hypothesis that the prognostic performance of TRISS could be improved by adding SAPS II.


METHODS
Prospective multicenter cohort study comprising 5,538 trauma patients out of 35,637 patients admitted to 31 ICUs in Austria over a 4-year period.


RESULTS
Separately, TRISS and SAPS II showed lack of calibration in the cohort of trauma patients. The database was then split into two equal samples, development and validation. Using the development sample, a new scoring system was developed, with vital status at hospital discharge as the dependent variable and TRISS and SAPS II as independent variables. The prognostic performance of the new TRISS-SAPS system was then assessed in the validation cohort: Both, discrimination (as shown by area under the ROC curve), and calibration (using Hosmer-Lemeshow goodness-of-fit statistics) was excellent.


CONCLUSIONS
We improved risk adjustment in critically ill trauma patients by combining TRISS and SAPS II. This new scoring system might aid in evaluating and comparing specialized trauma ICUs.
Reiter
Ana
A
Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria.
Mauritz
Walter
W
Jordan
Barbara
B
Lang
Thomas
T
Pölzl
Alexandra
A
Pelinka
Linda
L
Metnitz
Philipp G H
PG
D018806:APACHE; D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D002138:Calibration; D015897:Comorbidity; D016638:Critical Illness / Q000145:classification / Q000401:mortality; D016002:Discriminant Analysis; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000401:mortality; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012372:ROC Curve; D020379:Risk Adjustment / Q000379:methods* / Q000592:standards; D016019:Survival Analysis; D015599:Trauma Severity Indices