EVALUATION OF TRISS AS A MEANS OF SELECTING TRAUMA DEATHS FOR CLINICAL PEER-REVIEW

This study was carried out to evaluate the predictive power of a mathe matical model called TRISS in identifying avoidable trauma deaths when compared with peer review (PR). The subjects studied comprised the 24 deaths that occurred among 81 severely injured patients (Injury Sever ity Score greater-than-or-equal-to 16) admitted to a trauma unit over a 1 year period. Sixteen patients who had a > 50% probability of survi val (Ps) calculated by TRISS died. Peer review concluded that five of those were potentially avoidable deaths. Eight deaths occurred in pati ents with a Ps less than 50%. Peer review regarded those eight as inev itable deaths. The data, when analysed, showed TRISS to have a 100% se nsitivity, 42% specificity, 31% positive predictive value and a negati ve predictive value of 100% when compared with peer review. It is conc luded that TRISS tends to over-estimate potentially avoidable death, e specially in patients with severe head injury. However it is a good au dit filter as it reliably excludes inevitable death.