Acute Physiology and Chronic Health Evaluation (APACHE) III Score compared to Trauma-Injury Severity Score (TRISS) in Predicting Mortality of Trauma Patients.
BACKGROUND
More than 50 scoring systems have been published for classification of trauma patients in the field, emergency room, and intensive care settings, so far. The present study aimed to compare the ability of trauma injury severity score (TRISS) and acute physiology and chronic health evaluation (APACHE) III in predicting mortality of intensive care unit (ICU) admitted trauma patients.


METHODS
This prospective cross-sectional study included ICU admitted multiple trauma patients of Imam Hossein and Hafte-Tir Hospitals, Tehran, Iran, during 2011 and 2012. Demographic data, vital signs, mechanism of injury and required variables for calculating APACHE III score and TRISS were recorded. The accuracy of the two models in predicting mortality of trauma patients was compared using area under the ROC curve.


RESULTS
152 multiple trauma patients with mean age of 37.09 ± 14.60 years were studied (78.94% male). 48 (31.57%) cases died. For both APACHE III and TRISS, predicted death rates significantly correlated with observed death rates (p < 0.0001). The mean age of dead patients was 37.21 ± 14.07 years compared to 37.03±14.96 years for those who survived (p = 0.4). The area under ROC curve was 0.806 (95% CI: 0.663-0.908) for TRISS and 0.797 (95% CI: 0.652-0.901) for APACHE III (p = 0.2).


CONCLUSIONS
Based on the results of this study, both TRISS and APACHE models have the same accuracy in predicting mortality of ICU admitted trauma patients. Therefore, it seems that TRISS model would be more applicable in this regard because of its easier calculation, consideration of trauma characteristics, and independency of patient care quality.
Emergency Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Parvin
P
Darbandsar Mazandarani
Emergency Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Kamran
K
Heydari
Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ; Safety Promotion and Injury Prevention Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hamidreza
H
Hatamabadi
Emergency Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Parvin
P
Kashani
Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Yasin
Y
Jamali Danesh
APACHE; Trauma severity indices; injury severity score; multiple trauma