Assessment of trauma scoring systems in patients subjected to exploratory laparotomy

ABSTRACT Objective: to assess the epidemiological profile of patients undergoing exploratory trauma laparotomy based on severity and prognosis criteria, and to determine the predictive accuracy of trauma scoring systems in terms of morbidity and mortality. Methods: retrospective cohort study and review of medical records of patients undergoing exploratory laparotomy for blunt or penetrating trauma at the Hospital de Pronto Socorro de Porto Alegre, from November 2015 to November 2019. Demographic data, mechanism of injury, associated injuries, physiological (RTS and Shock Index), anatomical (ISS, NISS and ATI) and combined (TRISS and NTRISS) trauma scores, intraoperative findings, postoperative complications, length of stay and outcomes. Results: 506 patients were included in the analysis. The mean age was 31 ± 13 years, with the majority being males (91.3%). Penetrating trauma was the most common mechanism of injury (86.2%), predominantly by firearms. The average RTS at hospital admission was 7.5 ± 0.7. The mean ISS and NISS was 16.5 ± 10.1 and 22.3 ± 13.6, respectively. The probability of survival estimated by TRISS was 95.5%, and by NTRISS 93%. The incidence of postoperative complications was 39.7% and the overall mortality was 12.8%. The most accurate score for predicting mortality was the NTRISS (88.5%), followed by TRISS, NISS and ISS. Conclusion: the study confirms the applicability of trauma scores in the studied population. The NTRISS seems to be the best predictor of morbidity and mortality.

摘要
【研究目的】基于严重程度与预后标准，评估接受创伤探查剖腹术患者的流行病学特征，并明确创伤评分系统在并发症发生率与病死率预测中的准确性。
【研究方法】本研究为回顾性队列研究，选取2015年11月至2019年11月期间，于阿雷格里港急救医院（Hospital de Pronto Socorro de Porto Alegre）接受针对钝性创伤或穿透性创伤的剖腹探查术的患者，对其病历资料进行回顾分析。收集的研究指标包括：人口统计学数据、创伤致伤机制、合并损伤、生理类评分（修正创伤评分（Revised Trauma Score, RTS）与休克指数）、解剖类评分（损伤严重度评分（Injury Severity Score, ISS）、新损伤严重度评分（New Injury Severity Score, NISS）及简明创伤指数（Abbreviated Trauma Inventory, ATI））、联合类评分（创伤损伤严重度评分（Trauma Injury Severity Score, TRISS）与新创伤损伤严重度评分（New Trauma Injury Severity Score, NTRISS））、术中所见、术后并发症、住院时长与临床转归。
【研究结果】本研究共纳入506例患者进行分析。患者平均年龄为31±13岁，其中男性占比91.3%，为研究人群的主体。穿透性创伤为最常见的致伤机制（86.2%），其中以火器伤最为多见。患者入院时的平均修正创伤评分（RTS）为7.5±0.7。损伤严重度评分（ISS）与新损伤严重度评分（NISS）的平均值分别为16.5±10.1与22.3±13.6。创伤损伤严重度评分（TRISS）估算的生存概率为95.5%，新创伤损伤严重度评分（NTRISS）估算的生存概率为93%。术后并发症发生率为39.7%，总体病死率为12.8%。预测病死率准确性最高的评分系统为新创伤损伤严重度评分（NTRISS，准确率88.5%），其次依次为创伤损伤严重度评分（TRISS）、新损伤严重度评分（NISS）与损伤严重度评分（ISS）。
【研究结论】本研究证实了创伤评分系统在本次研究人群中的适用性，其中新创伤损伤严重度评分（NTRISS）似乎是并发症发生率与病死率的最佳预测指标。