The Predictive Value Of Combination Of Anatomy Scoring System And Physiological Scoring System In Poor Outcomes After Severe Trauma

ObjectiveTo compare the predictive value of anatomy scoring system and physiological scoring system and the combination of two systems in poor outcomes of intensive care unit(ICU) severe multiple-injury patients.MethodsA total of 539 multiple-injury patients with ISS≥16,older than 16 years, treated within 24 hours after trauma, not transferred from another hospital, length of ICU stay≥48 hours,admitted to ICU of the third-grade class-A hospitals between 2010 and 2014.Recording injury severity score(ISS), new injury severity score(NISS), acute physiology and chronic health evaluation II(APACHE II), sequential organ failure assessment score(SOFA) and poor outcomes(sepsis, MODS and death),only 180 cases had SOFA.(1) Calculated the AUC,evaluated the scoring system alone and combination of the predictive power of poor outcomes in severe multiple-injury patients.(2) Comparison the ability of SOFA and NISS+APACHE II in prediction poor outcomes of severe multiple-injury patients.ResultsISS,NISS,APACHE Ⅱ,ISS+APACHE Ⅱ,NISS+APACHE Ⅱ of the groups with sepsis,MODS and death were significantly higher than the groups which did not happen(P<0.05).The AUC of ISS、NISS、APACHEII、ISS+APACHEII and NISS+APACHEII in predicting sepsis were 0.654、0.730、0.743、0.772 and 0.804; in predicting MODS were 0.611、0.693、0.719、0.727 and 0.764; in predicting death were 0.713、0.830、0.804、0.862 and 0.901,respectively. NISS+APACHEII had larger AUC than others in predicting poor outcomes of severe multiple-injury patients(P<0.05). The AUC of NISS+APACHEII and SOFA in predicting sepsis were 0.806 and 0.700; in predicting death were 0.914 and 0.790.In predicting MODS with 2 or more injury organs,the AUC of NISS+APACHEII and SOFA were 0.827 and 0.861(P > 0.05); in predicting MODS with 3 or more injury organs,the AUC of NISS+APACHEII and SOFA were 0.789 and 0.831(P>0.05); in predicting MODS with 4 or more injury organs, the AUC of NISS+APACHEII and SOFA were 0.791 and 0.903(P<0.05). NISS+APACHEII had larger AUC than SOFA in predicting sepsis and death(P < 0.05). In predicting MODS,SOFA had larger AUC than NISS+APACHEII, olny when body suffered 4 or more injury organs(P<0.05).Conclusion(1) In predicting sepsis and death of severe multiple-injury patients of ICU, NISS+APACHE II showed better value than ISS,NISS,APACHE II,ISS+APACHE II and SOFA.(2)In predicting MODS, NISS+APACHE II owned better ability than ISS,NISS,APACHE II and ISS+APACHE II.Compared with SOFA,the capacity of SOFA was stronger olny in predicting 4 or more injury organs.