title: [The predictive value of combination of anatomic scoring system and physiological scoring system in prediction of death in patients with severe trauma: a multicenter analysis of 614 cases].
abstract: OBJECTIVE
  To compare the predictive value of anatomic scoring system, physiological scoring system, and the combination of two systems in death prediction of patients with severe trauma in intensive care unit (ICU).
  
  
  METHODS
  A retrospective analysis of patients with severe trauma admitted to department of critical care medicine of Daping Hospital, the Third Military Medical University, and Zunyi Medical University from January 2011 to December 2014 was conducted. The patients meeting the following criteria were enrolled: over 16 years old, admitted to hospital shorter than 24 hours after trauma, length of ICU stay ≥ 48 hours, and injury severity score ( ISS ) ≥ 16. Patients were divided into two groups: survivors and non-survivors. The data of anatomic scoring system, including ISS and new injury severity score (NISS), and physiological scoring system, including acute physiology and chronic health evaluation II (APACHEII) score were collected. The predictive power for death of the scoring system alone or combination in patients with severe trauma was evaluated.
  
  
  RESULTS
  A total of 614 patients with severe trauma were enrolled, and there were 153 deaths with a mortality rate of 24.9%. ISS, NISS, APACHEII, ISS + APACHEII, NISS + APACHEII of non-survivors were significantly higher than those of survivors (ISS: 29.15 ± 7.75 vs. 24.31 ± 6.50, NISS: 41.96±12.01 vs. 29.64 ± 8.19, APACHEII: 23.71 ± 6.58 vs. 17.02 ± 5.49, ISS + APACHEII: 52.86 ± 10.00 vs. 41.33 ± 8.70, NISS + APACHEII: 65.67 ± 13.46 vs. 46.66 ± 10.43, all P < 0.01). The area under receiver operating characteristic curve (AUC) of ISS, NISS, APACHEII, ISS + APACHEII, NISS + APACHEII was 0.687, 0.792, 0.782, 0.809, and 0.860, respectively. Both of ISS + APACHEII and NISS + APACHEII had higher AUC than that of ISS, NISS or APACHEII alone; and the AUC of NISS + APACHEII was significantly larger than that of ISS + APACHEII (all P < 0.05). NISS + APACHEII showed the largest AUC in death prediction of severe trauma patients. The cut-off value, sensitivity, specificity, positive predict value (+PV), negative predict value (-PV), positive likelihood ratio (+LR), negative likelihood ratio (-LR), and Youden index of NISS + APACHEII, which had the greatest AUC, were 56, 75.2%, 82.0%, 58.1%, 90.9%, 4.17, 0.30, and 0.572, respectively.
  
  
  CONCLUSIONS
  The combination of anatomic scoring system and physiological scoring system is better than single scoring system for death prediction in patients with severe trauma in ICU, and it may be considered to be a new method for early identification of death risk in patients with severe trauma.
authors.affiliation: Department 1, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing 400042, China. Corresponding author: Liang Huaping, Email: 13638356728@163.com.
authors.forename: Ya
authors.initials: Y
authors.lastname: Xiao
authors.forename: He
authors.initials: H
authors.lastname: Jin
authors.forename: Hong
authors.initials: H
authors.lastname: Mei
authors.forename: Xueyuan
authors.initials: X
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.forename: Zheng
authors.initials: Z
authors.lastname: Liu
authors.forename: Dongpo
authors.initials: D
authors.lastname: Jiang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Jun
authors.initials: J
authors.lastname: Yan
authors.forename: Huaping
authors.initials: H
authors.lastname: Liang
mesh_terms: D003422:Critical Care; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies