TAP CHi NGHIEN CU'U Y H p C .
DANH GIA DO TIN CAY QUA PHU'aNG PHAP TRISS S L F A D C I
TRONG TIEN LU'O'NG HAU QUA C H A N T H U ' Q N G Nguydn HiPu Tu Trwong Dgi hgc Y Ha NQI Nglven cuv ddnh gid dd tin cdy cua phwong phdp TRISS swa ddi trong tien luvng h$u qud cua chin thuong t^i benh vidn Vigt - Due KM qua nghien cuv cho thay Tong so bgnh nhdn 3772 (nam 78.8%, nU 21.2%), tuoi trung binh 34.7 ± 15,1. 323 b$nh nhdn tu- vong Higu lgc tidn luvng cua RTS- ROC = 0,9 (0.88 - 0.92, Cl 95%) Higu lgc tidn lugng cua ISS ROC = 0.91 (0.90 - 0.93. Cl 95%>) Do im cdy cua phuong phdp TRISS su-a doi ROC = 0,95 (0.92 - 0.97, Cl 95%,). Sn = 55%,. Sp = 9d.4%>. PPV = 76.6%, NPV = 95.8%. Ty Ig tien luvng sat (M) = 5,2%; va Z = 0.11 (p > 0.05) Phuung phdp TRISS swa doi cd kha nang tien luung tdt hau qua song chet sau chSn Ihuong tren Idm sang vdt dg tin cdy cao.
Tir khoa. c h i n thucng, TRISS, tir vong I. DAT V A N D ^
Danh gia dung dd nang ciia c h i n thuong va tien luong sdm theo cac tieu ehuan qudc t i cho phep dua ra edc q u y i t dinh xir tri diing ddn trong c i p ciru Danh gid do nang vd tien luang theo eae tieu chuan qudc te edn Id cdng cu tin cay vd edn t h i i t trong nghien eiru chdn thuong ndi chung, Id ea s d khoa hoc khr danh gia k i t qua dieu tn ciia tirng benh nhan ehan thuang hay ciia ca he t h i n g dieu tn | 1 , 4) Phuang phap TRISS (gdm bang d i i m RTS, ISS va tudi) da d u a c nghien ciru, thCra nhdn va dp dung rdng rai tai n h i i u trung tam chdn thuang tren t h i gidi Do s u khac nhau v i ddc d i i m dich td, mirc dd nang ciia chdn thuong va chdt luong ciia he thdng didu tri d mdi nu'de, TRISS duac dp dung vdi cdc hd sd chdn thuang ddc trung khdc nhau |2, 7| Tir nam i996, ehiing tdi da d u a cdc tieu chuan danh gia dd nang va tien luang c h i n thuong theo phuong phap TRISS vao nghien eiru va dp dung tai benh vien Viet Due, da tim ra cdc
Oia chl lien he Nguyen HO-u Tu. Bi5 n Dai hoc Y m NQI
Email nghuutu@yahoo com Ngaynh$n 18/04/2013 Ngay 6uoc chap thuan 20/6/2013
n Gay me hoi s
hd sd chan t h u a n g ddc trung ndng va cac sira doi trong phuong phdp TRISS phu hap vdi he thong cap ciru va dieu tn chdn thuang tai Viet Nam [1J
Vide t i i p tuc nghien ciru k i i m chirng dd tin cdy cua cdc tidu chuan s u doi ndy trong danh gia dd nang vd tidn luong c h i n thuong tai Viet Nam la rdt cdn t h i i t Vi vdy, ehiing tdi tiln hanh d i tdi nay nhdm mue tidu Danh gia do tin cay cua p h u a n g phap TRISS sira ddi trong tien luong hau qua cua chdn thuang tai benh vien benh vidn Viet Dire
II. D 6 | TU'ONG VA PHU'ONG PHAP
1, Ddi tu-ang
1 1. Tieu chuan lira chgn
Benh nhan c h i n thuong tuoi > 10, duoc thu thap vdo nghien eiru tai phdng khdm edp ciiu, khoa bdnh chdn thuang cua cac bdnh vien
Thdi gian tir khi bi tai nan d i n khi duoc phdu thuat < 72 gid
Chua duac can thiep ngoai khoa d nat khac Chua d u a c hdi sire tieh c u e bdng cac phuang phdp nhu- dat ndi khi quan, md khi quan, t h d mdy. tra tim mach, ehua duae diing thudc me hodc an than manh
TCNCYH 83 13) 2013
• TAP CHI NGHIEN CU'U Y HOC Khdng cd cac bdnh ndi khoa phoi hap nhu:
Tim mach, hd hap, Xae dmh bdng hdi true t i i p benh nhan hoae ngudi than va thdm khdm iam sang
1.2. Tieu chuan loai tru'
T h i i u cac d i i u kien lua chon dS ndu du'oc phat hidn khi h i p nhdn hodc trong qud trinh theo ddi, d i i u tn. tuoi, den benh vien qua mudn, da d u a c can thiep ngoai khoa hodc hoi sire tich cue, t i i n sir benh ndi khoa
Khdng duae danh gia d i y du theo cdc y i u td tien luang trong khi h i p nhdn vd d i i u tn benh nhan
Bdnh nhdn da chdt lam sang khi d i n benh vidn mdt tn gidc, ngirng thd, ngung tim
Benh nhdn tir vong trong benh vien do nguyen nhdn khae khdng hen quan vdi chdn thuang
2. Phu'O'ng phap
Thiet ke nghien CLPU: Nghien eu'u md ta, t i i n ciru Nghien ciru duac thue hidn tai phdng kham edp ciru vd eae khoa benh chdn thuang, khoa Gay me Hdi sire, bdnh vien Viet Due, tir ndm 2006 d i n nam 2008
Danh gia do nang va tien lu'O'ng theo phu'O'ng phap TRISS
Phuang phap TRISS thdng thudng [4]
Bang diem chdn thuang su-a doi ^RTS) ddnh gia tdn thuang sinh ly
Bang d i i m dd nang ton thuong (ISS) danh gid tdn thuang giai phdu
Tudi cua benh nhan vdi mde tuoi 55. A = 1 neu > 55, A = 0 n i u < 55 tuoi
Cac he sd c h i n thuang bo = -1,6465, b^ = 0,5175, b2 =-0,0739, b3 =-1,9.261
Kha nang sing sdt ciia tirng benh nhdn se la.
Ps = 1/(1 + e") Trong do b = bo+ biRTS + b2lSS + baA
(e la hdng sd Logarithm t u nhien cd gia tn 2,718282),
Phuang phdp TRISS sua doi duoc dp dung trong nghien eiru [1]
Mdc tuoi tldn luang 50 A = 1 neu > 50, A = 0 n i u < 50 tuoi Cdc hd so chan thuang ddc trung cho hd thong d i i u tn ehan thuang tai bdnh vidn Viet - Dire bo - -2,5841, bi 0,4012, b2= -0,0515, b3= -0,4930
Djnh nghTa cac bien so dau ra C h i t g i m cac benh nhdn tir vong d giai doan trong hodc sau mo, cdc benh nhdn duoc gia dinh xm v i d giai doan sau mo vi tinh trang qua ndng
Sdng sdt gdm nhCrng bdnh nhan xudt vien khdng c i n mdt hd tro ndo ve hd hdp va tuan hoan
3. Tien hanh nghien cii'u
Mdi bdnh nhan d u a c danh gia khi tidp nhan theo mau phieu in san, bao gdm dac d i i m dieh td chdn thuang, c h i n doan lam sang, t i i n sir, d i i m RTS, diem ISS, chan doan trong md, k i t qua d i i u tn
Xac dmh ede yeu td lien quan cua benh nhdn nhu tudi, thdi gian bi tai nan, tien sir benh tdt Hdi true t i i p n i u benh nhdn tinh tdo, qua ngudl thdn khi benh nhdn ed rdi loan tn gidc
Danh gid d i i m RTS gom
- Danh gia tn giae theo thang d i i m Glasgow - D i m t i n sd thd trong mdt phiit dua vao di ddng ciia ldng nguc
- Do huyet dp ddng mach t i i da bdng may do t u ddng (may Dinamap)
Danh gid ton thuang giai phdu theo ISS dua vdo
- C h i n doan lam sang va can Idm sang truac mo
Chdn doan t i n thuang trong md cua phdu thudt vien
TCNCYH 83 (3)-2013
TAP CHi NGHIEN CU'U Y HQC • Ton thuang phdt hien thdm trong thdi gian ndm vien
- Ton thuang phat hidn thdm khi m6 tir thi niu cd,
Theo ddi trong bdnh vien
Bdnh nhdn duoe theo ddi trong bdnh vien n h i m ghl nhdn vd phdt hidn cac b i i n ehu'ng, s i ngdy phai thd may hodc tro tim mgch, eae didn b i i n b i t thuong cimg nhu k i t qud dieu tn song sdt hay tii' vong
Nguyen nhdn tii' vong du'OC dua ra duia tren ton thuang do chdn thuong, d i i n b i i n trong qud trinh dieu tn, k i t ludn ciia cdc bdc sy chuydn khoa vd k i t qua giai phdu bdnh ly n i u c^ P h i i u nghien eii'u eiia ede benh nh-'.n se duoc hoan thien, cho diem theo cac bang diem chan thuang So lieu du'OC luu trU vd xu ly bdng chuang trinh SPSS 12 0
3. Phan tich s6 lieu
Danh gia gia tn tien luang ciia cac thang diem nay khi diing mdt each neng le b i n g dd nhay (Snj. do dac hieu (Sp), hieu luc tien luang (ROC - Receiver Operating Curve)
Kha nang s i n g sdt eua mdi bdnh nhdn (Ps) duac duac xac dmh theo phuang trinh ,,6i quy Xac dinh hieu luc tidn lu'ong (ROC - Re- ceiver Operating Curve)
Kiem dmh dd tin cay ciia TRISS Ps [possibility of survival) = 0,5 d u a c coi Id ranh gidi phdn dmh de tidn luang sdng c h i t D d tin cay ciia phuang phdp TRISS trong hdn luang t h i hien bang su khdp nhau giu'a Ps d u doan theo TRISS va tinh trang song chet trong {hue t i duac k i i m dmh bang trdc'nghiem Z va kha ndng tien luong sai M (misclassifieahon) = (FNN + FPN)/n Trong do FNN Id s i trudng hap dm tinh gia, FPN la sd truang hap d u a n g Unh gia, n Id so benh nhan nghien ciru
4. Khia c a n h dao 6iyc
Nghien ciru md ta, duac thue hien bm ngudl nghidn eiru ddc Idp vi vdy eae s6 li$u d u v c thu thdp bdi nhdm nghidn cuu khong ldm thay doi c h i i n luo'c vd bien phap didu tn trdn nhUng bdnh nhdn cu the trong sudt quS trinh nghidn ciru Nghidn ciru khdng vi pham cdc quy t i e dao dire doi vdi mdt nghien ci>u Idm sdng K i t qua eua nghien ciru duoc hy vong sd giiip thay doi theo hudng tich ci;c each danh gid dd nang va hen luang chan thuong trdn Idm sang cung nhu d i i vdi viec ddnh gia khdch quan k i t qua d i i u tn benh nhan chdn t h u o n g
III. KET QUA
1. Mot s d dac d i e m cua benh nhan Tdng so benh nhan d u o c dua vao nghien CU'U 3772
Nam 2971 (78,8%), nu- 801 (21.2%), Tuoi trung binh 3 4 , 7 + 15,1 ( 1 5 - 9 2 )
Loat tai nan giao thdng 2494 (66,1%), lao ddng 430 (11,4%), smh hoat 847(22.5%)
S6 vung tdn thuung tren mot benh nhan 3268 benh nhan (86,6%) ed 1 viing ton thuong, 364 (9,7%) ed 2 vung ton thtrong.
119 (3.2%) cd 3 viing ton thuong, 21 (0,53%) cd 4 - 5 vting t i n t h u o n g
Chdn doan tdn thuong da c h i n thirong 233 (6,2%); chdn t h u a n g so nao 1162 (30.5%), Chan t h u a n g hdm mdt 111 (2,9%), chdn thu'ong nguc 180 (4,8%); chdn thirong bung 80 (2,1%); chdn thuong ehi 1128 (29,9%) chdn t h u a n g da 66" (1.7%).
2. K i t qua dp d u n g TRISS siJa ddi trong tien lu'O'ng c h a n t h u ' c n g
D i i m RTS va hau qua c h d n thu'o-ng
TCNCYH 83 (3) - 2013
- TAP CHI NGHIEN CU'U Y HQC Bang 1. Phan bo ty le benh nhan sdng sdt va tir vong theo diem RTS Di^m RTS
0 1 2 3 4 6 6 7 8 9 10 11 12 T6ng so
Benh nhan sdng (%) 0 0 0 0 0 1 2 (20%) 3(13,7) 17(32,7) 71 (48,0%) 268 (76,8%) 499 (92,6%) 2588 (99%) 3449(91,5%)
Benh nhan tip vong (%) 8
•4 6 4 7 7 8 (80%) 19(86,3%) 35 (67,3%) 77 (52,0%,) 81 (23,2%) 40 (7,4%) 27(1%) 323 (8.5%)
T6ng 8 4 6 4 7 8 10 22 52 148 349 539 2615 3772
(Diem cang thap, tien luang cang nang, ROC = 0,9 (0,88 - 0,92, Cl 95%) D i i m ISS va hau qua chdn thu'O'ng
Bang 2. Phan bd ty le benh nhan sdng sdt va tli' vong theo diem ISS Di6m ISS
< 9 9 - 1 5 1 6 - 2 4 2 6 - 4 0
> 4 0 T6ng s6
Benh nhan song 996 (99,6%,) 1780(99,4%) 584(85,1%) 86 (34,8%) 3 (6,3%) 3449(91,5%)
(%)
Benh nhan tu" vong (%,) 4 (0,4%) 10(0,6%) 103(14,9%) 161 (65,2%,) 46(93,7%) 323(8,5%)Tong 1000 1790 687 247 48 3772
(Diem cang cao, tien lifcmg cang nang, ROC = 0,91 (0,90 - 0,93, Ci 95%)
TCNCYH 83 (3)-2013
TAP CHi NGHIEN CU'U Y HQC Tudi va hau qua chdn thu-ang
Bang 3. Phan bd ty Id sdng sot va ty le tu- vong theo cdc khoang mdc ludi
M 6 C tuoi 1 0 - 1 9 2 0 - 2 9 3 0 - 3 9 4 0 - 4 9 5 0 - 5 9 6 0 - 6 9 7 0 - 7 9 8 0 - 8 9
> 9 0 Tong so
Bang 4 Tu6i Diem ISS
< 50 10,9 + 7,4
> 50 11 T6ng
1 ± 7 , 7
Benh nhan s6ng (%) 460 (92,8%.) 1131 (93,3%) 729(91,6%) 594 (90,9%) 289(88,1%) 131 (84,0%) 83(88,3%)
30 (88,3) 2 3449(91,5%,)
. Phan b6 benh nhan sdng Benh nhan sdng (%)
2914 (92,3%,) 635(87,1%,) 3449(91,6%)
Benh nhan tu> vong {%) 36 (7,2%) 81 (6,7%) 67 (8,4%,) 6 0 ( 9 , 1 % ) 39(11,9%) 25 (16,0%,) 11 (11,7%) 4(11,7%,)
0 323 (8,6%,)
sot va tLF vong theo moc tuoi
Benh nhan ttr vong (%}
244 (7,7%) 79 (12,9%,)' 323 (8,5%)
TSng 496 1212 796 654 328 156 94 34 2 3772
Ting 3158 614 3772
Khong co siy khac biet ve d i l m ISS giua 2 nhom tuoi, "p < 0,05 so vai nhom tuoi < 50 Kha nang song sot cua benh nhan ch^n thu'O'ng
Ps 77.4 ± 15,3% (0,3 - 88,3%)
Bang 5. Phan b i kha nang s6ng sot va tinh trang s6ng ch§t trong thiec tS Benh nhan ttj vong (%) Benh nhan s6ng {%} Tong
177(76,6%o) 54 (23,4%,)
146(4,1%) 3395 (95,8%,)
T6,lg 323 (8,5%o)
p < 0.01 so V&I nhom Ps > 50%
3449(91,5%)
TCNCYH S3 (3) 2013
• TAP CHl NGHIEN CU'U Y HOC
.r
Hinh 1. Dien tich du'O'i du'O'ng cong (ROC = 0,95) hay hieu l i f c tien lu'O'ng cua Ps ddi v d i t i n h trang t i f v o n g do chdn thu'O'ng
Sn (dd nhay), Sp (dd dac hieu) ROC = 0,95 (0,92 - 0,97, Cl 95%), Sn = 55%, Sp = 98,4%, PPV = 76,6%, NPV - 95,8%
Ty le tien luang sai (M) = 5,2%
Su phil hap giUa kha nang sdng sdt (Ps) d u dodn vd tinh trang sdng chdt trong thue td Z = 0,11, ( p > 0 , 0 5 )
' IV. BAN LUAN
Tuong t u nhu thdng bdo cua nhieu nghien cuu eua ede tac gia trong nudc, da sd benh nhdn eua chung tdi la nam gidi Tudi trung binh cua cdc nan nhdn edn rdt tre, dae biet d lua tudi 20 - 40 Chan thuong so nao va chdn thuang chi Id cdc loai ton thuong thudng gap nhdt Da chdn thuang chidm ddn 6,2% cho thdy benh canh phirc tap vd ndng nd trong , edp cuu chdn thuang tai benh vien Viet Due
Da sd benh nhdn cd 1 vung ca quan ton p thuang, tuy nhidn cung ed tren 13% benh
"_ nhdn ed it nhdt 2 viing ton thuong.
^ Tai nan giao thdng Id nguyen nhdn ehu yeu
> vd phdn Idn lien quan ddn xe mdy Xe may la .• nguyen nhdn tai nan hdng dau da duoc xdc -' nhan trong hdu hdt eae nghidn eiru trong
nhidu nam gdn ddy [1, 3, 5]
Gia tn tien luong sdng - chet eua phuong phap TRISS
Ket qua dp dung tai benh vien Viet Dire cho thdy RTS, ISS va tudi benh nhdn deu ed gia trj thuyet phue trong phdn loai dd nang va tldn luong chdn thuang (bang 1) Tdng hap cac yeu td tien luang tren theo phuang phap TRISS eho phep xdc dinh kha nang sdng sdt (Ps) cho tu'ng benh nhan chdn thuang
Ps = 0,5 (50%) duac coi la ranh gidi phan dmh kha nang sdng - chdt cua cac bdnh nhan chan thuang [2] Ps < 0,5 ddng nghia vdi kha ndng tir vong cao vd khd trdnh khdi Nguac lai Ps cdng gdn tai 1 kha ndng sdng sdt edng cao, nguy c a t u vong cang thdp Gid tn tien luong eua TRISS eao hay thdp phu thudc vao mire dd phii hop giCra eae trudng hap sdng sdt hay tir vong theo d u doan va tinh trang sdng - chdt trong thuc td lam sang Vdi Z - 0,11, nghien ciru eua chung tdi eho thdy khdng eo s u khae biet cd y nghTa giO'a du
TCNCYH 83 (3)-2013 57
TAP CHi N G H l i N CCfU Y H p C • doan vd thiirc te hay phuong phdp TRISS cd gid tri trong vide tidn luong s6ng - ch^t cdc bdnh nhdn chdn thuang,
Vdl hidu lire tldn luc?ng ROC 0.95, gid tn hen dodn duang tinh (PPV) Id 76.6% vd kha ndng tidn luong sai ndi chung M 5,2%
nghidn cuu ndy cho thay phuang phdp TRISS cho phdp tldn luo'ng song - chet chinh xdc hon cdc bang di^m RTS, ISS (bang 2) khi su' dyng neng le K^t qua tuang tg' cijng dd d u a c khdng djnh trong nghidn ciru trude ddy cua ede tdc gia nudc ngoai |5, 10) Phuang phdp TRISS dd tong hap d u o c tat ca cdc yeu to tldn luang quan trqng nhat tren Idm sdng, chinh vi vdy dd ndng cua bdnh nhdn chan thuang trdn Idm sdng dd duac ddnh gia day du nhat
Dien tich d u d i dudng cong (ROC) hay hidu luc tien luong tang tir 0,5 den 1,0 the hidn mire dd chinh xac trong phdn loai eae trudng hap ROC = 0,7 duae eoi la gid tn tdi thieu chdp nhan duae ddi vdi viec thira nhdn mdt phuang phdp tien luong [2] Nhu vdy cd the COI phuang phdp TRISS Id mdt phuong phap tldn luang ldm sdng dang tin cdy ddi vdi eae benh nhan chan thuang tai benh vien dd duac ap dung
Tir khi duoc edng bd vdo ndm 1989, phuang phdp TRISS' d u o c thira nhdn va s u dung tai nhieu nudc tren thd gidi Da sd edc nghien ciru deu xae nhdn do hn cay can thiet cua phuang phap tien luong ndy vdi hidu luc tldn luong giao ddng t u 0,8 - 0,98 [5; 10]
Nghien cii'u cua chiing tdi cho phdp khdng dmh them gia tn hen luo'ng sdng - chdt cua phuang phdp TRISS doi vdi edc bdnh nhan Chan thuang ndi chung Phuang phdp TRISS vdl SI/ sua doi eua moc tuoi vd cac trong s6 chdn thuang ddc trung tai bdnh vien Viet Dire cd dd tin cay cao trong tien luang sdng - chdt khi apdung thifc td
Ty Id tldn luo'ng sai trong nghien cd-u cO chOng tdi Id 5,2% bao gdm ea tien luong sonc sdt vd l u vong Dieu nay cho thay phuong phdp TRISS cd the ddnh gid do ndng cao hor hodc n g u a c lai thap han thuc td Da so b^nh nhdn c6 tidn luo'ng sai Id benh nhdn da chan thuang, tiep theo Id chan thuang so ndodtrn thudn cho th^y ddy chinh la hai nhdm benh nhdn md phuang phdp TRISS cd nguy ca ddnh gid thidu chinh xae nhieu han ca. Nguy c a ddnh gid ndng han t h y c te (overestimate) CLia TRISS chu ydu gdp d benh nhdn da ch^n thuang trong khi nguy c a ddnh gid nh? hon thuc te (underestimate) ehu yeu d bdnh nhan chan thuang so ndo Dieu ndy phu hop voi bdnh canh cua hai loai chdn thuang nay da chdn thuang co nhidu ydu td ed the lam benh nhdn d u a e danh gia nang han thue te, trong khi benh nhdn chdn t h u o n g so nao cd theti^r tnen xdu di nhanh ehdng sau chan thuong.
Day la ly do phuang phap TRISS vdn tidp tuc duae nghien cuu vd hoan chinh [11,12]
V. K £ T LUAN
Nghien cuu tren 3772 benh nhdn chan thuang tai benh vien Viet Dire, chiing tdi nhan thay phuang phap TRISS sir doi cd kha nang tldn luang tdt hdu qua ehan thuong tren l^m sdng vdl do tin cay cao
Lo"! c a m e n
Xm tran trong cdm a n ede ddng nghiep Gdy md hdi sire va Ngoai khoa, bdnh vien Vidt Dire 63 giiip d d tdi trong qud tfinh nghien ciru Trdn trong cam o n khoa GSy me hoi sire va cac khoa phdng hdn quan cua benh vien Viet - Que da tao didu kien cho toi thuc hien nghien ciru nay.
TAI LIEU THAM K H A O
1. Nguydn HO-u Tii (2003). Nghien ci/u phuang phdp TRISS s u doi trong tien lifong
TCNCYH 83 (3) 2013
• TAP CHI NGHIEN CU'U Y HOC vd danh gia kdt qua benh nhdn chdn thuang
phai mo Ludn dn tidn sy y hoc, Trudng Dai hoc Y H d Ndi
2. Boyd CR, Tolson MA, Copes WS (1987). Evaluating trauma care The TRISS method, J. Trauma. 27, 370 - 378
3. Baker SP, O'Neill B (1976) The injury se- verity score an update J Trauma. ^6, 882-885 4. Champion HR, Sacco WJ, Carnazzo AJ et al (1989). n revision of the Trauma score J. Trauma, 29, 623 - 629
5. Bull JP, Dickson GR (1991) Injury sconng by TRISS and ISS/Age Injury, 2, 127-131
6. Anthony RG (1995). TRISS unexpected survivors-a statistical phenomenon J Trauma. 33, 734 - 748
Corbanese U, Possamai C, Casagrande L et al (1996) Evaluation nf trauma care validation of the TRISS method in an Italian ICU Intensive Care Med, 22, 941 - 946
8. Demetriades D, Chan LS, Velmahos G et al (1998) TRISS methodology in trauma the need for alternatives Br J Surg. 85, 379 - 384
9. Kuwabara K, Matsuda S, Imanaka Y, Fushimi K et al (2010) Injury Severity Score, Resource Use, and Outcome for Trauma Pa- tients Within a Japanese Administrative Data- base J. Trauma, 68, 463 - 470
10. Nils OS, Torsten E, Fetter AT (2006).
Assessing quality of care in a trauma referal centre Benchmarking performance by TRISS- based statistics or by analysis of stratihed ISS data J Trauma. 60, 538 - 547
11. Brenneman FD, Boulanger BR, et al (1998). Measuring injury severity Time for a change J Trauma, 44, 580 - 582
12. Cayten CG, Stahl WM, Murphy JG et al (1991). Limitations of the TRISS method for interhospital comparisons A multihospital study J Trauma, 3 1 , 471 - 482
Summary
IDENTIFYING RELIABILITY OF MODIFIED TRISS METHODOLOGY AS A TOOL FOR OUTCOME PROGNOSIS IN TRAUMA PATIENTS
The purpose of this study was to identify the reliability of modihed TRISS methodology as a tool to predict the prognosis in trauma patients at Viet Due hospital The results indicated that 78 8% (2971/3772) of patients were male, 21 2% were female 323 (8 5%) patients died ROC of RTS = 0,9 (0-88 - 0 92, Cl 95%), ROC of ISS - 0 91 (0 90 - 0 93, Cl 95%), Modified TRISS methodology in use showed ROC = 0 95 (0,92 - 0 97, Cl 95%), Sn = 55%. Sp = 98 4%. PPV = 76.6%, NPV = 95.8%; M = 5 2%, and Z = 0 11 (p > 0,05) In conclusion, modified TRISS method- ology IS a reliable tool to predict the prognosis in trauma pahents.
Key words: Trauma, TRISS, death
TCNCYH 83 (3)-2013