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目的探讨改良修正创伤评分(HB-RTS)系统对躯干伤伤员死亡风险的预测效能。方法按照1︰1配对的病例对照研究的原则,收集2011年7月-2013年10月收治的躯干伤伤员的临床资料,依据伤员受伤28 d内的生存预后进行分组。分别计算两组伤员的HB-RTS、修正创伤评分(RTS)、创伤严重度评分(ISS)。并进一步绘制受试者工作特征(ROC)曲线,计算出曲线下面积(AUC)和约登指数。然后,依此筛选出HB-RTS评分和RTS评分预测躯干伤伤员死亡的最佳截断值,计算二者的灵敏度、特异度和准确率等指标。最终采用线性相关分析探究HB-RTS评分和RTS评分与ISS评分的相关性。结果除RTS评分之外,死亡组伤员的HB-RTS评分与ISS评分均高于存活组,差异有统计学意义(P<0.05);两组的HB-RTS和RTS的AUC分别为0.922和0.888,灵敏度分别为91.5%和83.0%,特异度分别为95.7%和76.6%。同时,RTS和HB-RTS评分分别与ISS评分的相关系数为-0.592和0.585。结论 HB-RTS评分较RTS评分的ROC曲线AUC大、特异度升高、灵敏度下降;HB-RTS评分与ISS评分的相关性较RTS评分强。HB-RTS评分系统对躯干伤伤员对死亡预测效能较RTS评分更高。
Objective To investigate the predictive effectiveness of modified modified trauma score (HB-RTS) system on the risk of death from torso trunk injuries. Methods According to the principle of 1: 1 paired case-control study, the clinical data of the injured torso from July 2011 to October 2013 were collected and grouped according to the prognosis of survival within 28 days after injury. The HB-RTS, RTS and ISS scores of two groups were calculated. And further plotted the receiver operating characteristic (ROC) curve to calculate the area under the curve (AUC) and the Youden index. Then, the optimal cut-off value of HB-RTS score and RTS score for predicting the death of torso wounding patients was screened out, and the indexes such as sensitivity, specificity and accuracy were calculated. Finally, linear correlation analysis was used to explore the correlation between HB-RTS score and RTS score and ISS score. Results In addition to the RTS score, the HB-RTS score and ISS score of death group were higher than those of survival group (P <0.05). The AUC of HB-RTS and RTS were 0.922 and 0.888 , The sensitivity was 91.5% and 83.0%, the specificity was 95.7% and 76.6% respectively. At the same time, the correlation coefficients between RTS and HB-RTS scores and ISS scores were -0.592 and 0.585, respectively. Conclusions The ROC curve AUC of HB-RTS score is higher than that of RTS score, while the specificity is higher and the sensitivity is lower. The correlation between HB-RTS score and ISS score is stronger than that of RTS score. The HB-RTS scoring system had a higher prediction of mortality than the RTS for torso-injured individuals.