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Abstract
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OBJECTIVE: To evaluate the predictive value of a combination of anatomy scoring system and physiological scoring system for the diagnosis of multiple organ dysfunction syndrome (MODS) in patients with severe trauma.
METHODS: The clinical data of 539 patients with severe trauma hospitalized in ICUs of the First Affiliated Hospital of Chengdu Medical College, Daping Hospital of the Third Military Medical University, and the Affiliated Hospital of Zunyi Medical College from January 2010 to December 2014, conforming to the study criteria, were retrospectively analyzed. The patients were divided into MODS group (n=361) and non-MODS group (n=178) according to the diagnostic criteria of MODS. The data of Injury Severity Score (ISS), New Injury Severity Score (NISS), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, ISS+ APACHE Ⅱ score, and NISS+ APACHE Ⅱ score of patients on the first day of ICU admission were calculated and compared between the two groups. Data were processed with t test, chi-square test, and receiver operating characteristic (ROC) curves of the various scoring systems in 539 patients with severe trauma were plotted, and DeLong-DeLong non parametric test was used to evaluate the predictive ability for MODS of the various scoring systems.
RESULTS: The scores of ISS, NISS, APACHE Ⅱ, ISS+ APACHE Ⅱ, and NISS+ APACHE Ⅱ of patients in MODS group were respectively (26±8), (36±12), (21±7), (47±10), and (56±14) points, and they were significantly higher than those of patients in non-MODS group [respectively (24±6), (28±7), (16±5), (39±8), and (44±9) points, with t values from 4.970 to 12.120, P values below 0.01]. The total areas under ROC curves (95% confidence interval) of ISS, NISS, APACHE Ⅱ score, ISS+ APACHE Ⅱ score, and NISS+ APACHE Ⅱ score in MODS prediction of patients with severe trauma were respectively 0.611 (0.569-0.653), 0.693 (0.652-0.731), 0.719 (0.679-0.756), 0.727 (0.687-0.764), and 0.764 (0.726-0.799). The total areas under ROC curves of NISS, APACHE Ⅱ score, ISS+ APACHE Ⅱ score, and NISS+ APACHE Ⅱ score were significantly larger than the total area under ROC curve of ISS (with Z values from 3.505 to 7.179, P values below 0.001). The total areas under ROC curves of APACHE Ⅱ score and ISS+ APACHE Ⅱ score were larger than the total area under ROC curve of NISS, but there were no significant differences (with Z values respectively 0.931 and 1.657, P values above 0.05), while the total area under ROC curve of NISS+ APACHE Ⅱ score was significantly larger than that of NISS (Z=5.478, P<0.001). The total area under ROC curve of ISS+ APACHE Ⅱ score was larger than that of APACHEⅡ score, but there was no significant difference (Z=0.450, P=0.653), and the total area under ROC curve of NISS+ APACHE Ⅱ score was significantly larger than that of APACHE Ⅱ score (Z=2.554, P<0.05). The total area under ROC curve of NISS+ APACHE Ⅱ score was significantly larger than that of ISS+ APACHE Ⅱ score (Z=2.989, P<0.01).
CONCLUSIONS: The combination of NISS and APACHE Ⅱ score is more significant than ISS, NISS, APACHE Ⅱ score, and ISS+ APACHE Ⅱ score in prediction of MODS in patients with severe trauma.
Language: zh |