EVALUATION OF TRAUMA CARE - VALIDATION OF THE TRISS METHOD IN AN ITALIAN ICU

Objective: To validate the TRISS method as an audit system on a group of patients with severe trauma admitted to an Italian general intensiv e care unit (ICU). Design: Prospective, cohort study of consecutive ad missions to the ICU. Setting: A 6-bed general ICU in a 500-bed general hospital. Patients: 190 patients with severe trauma admitted from Jan uary 1992 to December 1993 were considered eligible. Patients lacking the data necessary to calculate the TRISS probability of survival, or for whom the ultimate outcome was unknown, were excluded. 162 patients were included in the study. Interventions: None. Outcome measure: Vit al Status at discharge from the last hospital that admitted the patien t for the trauma being considered. Results: The Hosmer-Lemeshow goodne ss-of-fit tests were: (H) over cap = 16.9, df = 10, p = 0.076; (C) ove r cap = 5.8, df = 10, p = 0.831. (H) over cap 3.5, df = 3, p = 0.31. T he area under the receiver operating characteristic curve was 0.963 (S E +/- 0.019). Classification measures at a decision criterion of 0.5 w ere. sensitivity 0.857, specificity 0.964, positive predictive value 0 .782, negative predictive value 0.978, total correct classification 0. 950, and the Youden index 0.831. The positive likelihood ratio (LHR) w as 24.17, whereas the negative LHR was 0.14. Conclusions: The results of the validation of the TRISS method showed adequate calibration and high discriminatory power in Italian ICU trauma patients also, allowin g confidence in the use of this method as an audit tool in our ICU. So me caution is advisable in extending these results to patients with op erable intracranial injuries, due to the relatively low number of such cases included in the study.