Key result
Combining TRISS with ASA-PS or NSQIP-SRC did not significantly improve mortality prediction compared to TRISS alone in trauma patients undergoing surgery within 24 hours (P=0.082 and P=0.394).
Why the study?
Trauma outcome prediction models have traditionally relied on injury and physiologic data without accounting for comorbidities, leaving uncertain whether adding comorbidity measures improves outcome prediction.
Do ASA-PS and NSQIP-SRC improve the predictive ability for mortality, LOS, and complications compared to TRISS alone in trauma patients undergoing surgery within 24 hours?
Observational (n=1,213)
Yes
Do ASA-PS and NSQIP-SRC improve the predictive ability for mortality, LOS, and complications compared to TRISS alone in trauma patients undergoing surgery within 24 hours?
p-value: p=0.082 and 0.394
TRISS remains the best predictor of mortality in trauma patients undergoing early surgery, while NSQIP-SRC is more accurate for predicting length of stay and complications.
Supports retaining TRISS alone for mortality prediction in early trauma surgery; leaves open NSQIP-SRC value for LOS and complications in prospective studies.
BACKGROUND: Trauma outcome prediction models have traditionally relied upon patient injury and physiologic data (eg, Trauma and Injury Severity Score [TRISS]) without accounting for comorbidities. We sought to prospectively evaluate the role of the American Society of Anesthesiologists physical status (ASA-PS) score and the National Surgical Quality Improvement Program Surgical Risk-Calculator (NSQIP-SRC), which are measurements of comorbidities, in the prediction of trauma outcomes, hypothesizing that they will improve the predictive ability for mortality, hospital length of stay (LOS), and complications compared to TRISS alone in trauma patients undergoing surgery within 24 hours. METHODS: A prospective, observational multicenter study (9/2018-2/2020) of trauma patients ≥18 years undergoing operation within 24 hours of admission was performed. Multiple logistic regression was used to create models predicting mortality utilizing the variables within TRISS, ASA-PS, and NSQIP-SRC, respectively. Linear regression was used to create models predicting LOS and negative binomial regression to create models predicting complications. RESULTS: From 4 level I trauma centers, 1213 patients were included. The Brier Score for each model predicting mortality was found to improve accuracy in the following order: 0.0370 for ASA-PS, 0.0355 for NSQIP-SRC, 0.0301 for TRISS, 0.0291 for TRISS+ASA-PS, and 0.0234 for TRISS+NSQIP-SRC. However, when comparing TRISS alone to TRISS+ASA-PS ( P = .082) and TRISS+NSQIP-SRC ( P = .394), there was no significant improvement in mortality prediction. NSQIP-SRC more accurately predicted both LOS and complications compared to TRISS and ASA-PS. CONCLUSIONS: TRISS predicts mortality better than ASA-PS and NSQIP-SRC in trauma patients undergoing surgery within 24 hours. The TRISS mortality predictive ability is not improved when combined with ASA-PS or NSQIP-SRC. However, NSQIP-SRC was the most accurate predictor of LOS and complications.
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Yeates et al. (2023) conducted an observational in Trauma requiring surgery (n=1,213). TRISS combined with ASA-PS or NSQIP-SRC vs. TRISS alone was evaluated on Mortality (p=0.082 and 0.394). Combining TRISS with ASA-PS or NSQIP-SRC did not significantly improve mortality prediction compared to TRISS alone in trauma patients undergoing surgery within 24 hours (P=0.082 and P=0.394).
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