| CHARACTERISTICS OF MULTIPLE TRAUMA AND QUALITY ASSURANCE OF TRAUMA CARE |
| Sung Ha Mun, Kyung Suk Chung |
| Department of Surgery, College of Medicine, Hallym University |
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Published online: July 31, 1994. |
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| ABSTRACT |
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While trauma is well known as a major cause of death and disability in Korea, but trauma severity indices has not been routinely used in trauma center. The purpose of this study was to better characterize trauma in a urban trauma center and to evaluate quality of trauma care.
We retrospectively studied 255 patients(mean age : 30.5 years, 200 male and 55 female) who had undergone abdominal operation for multiple trauma at the Kangnam Sacred Heart Hospital, Seoul, from January 1, 1988 through December 31, 1992.
A comparison between survivors and nonsurvivors showed significant difference in injury severity score(ISS, 18.9 vs. 39.8), revised trauma score(RTS, 7.4vs. 4.7), TRISS Ps(probability of survival, 0.66 vs. 0.14), and abdominal trauma index(ATI, 13.8 vs. 32.3).
The most common injury mechanism was motor vehicle crash (MVC, n = 123, 48.3% ) followed by other blunt(n - 70, 27.5% ) and penetrating injuries(n = 62, 24.3% ), MVC patients had higher ISS(23.9 vs. 16.6 and 16.7), higher ATI(17.1 vs. 13.5 and 12.5), higher actual mortality rate(9.8% vs. 1.6 % and 2.9% ), lower RTS(6.9vs. 7.6 and 7.5), lower TRISS Ps(0.54 vs. 0.75 and 0.70), and more lengthy hospital stay(69.2 days vs. 33.5 days and 28.8 days) than did patients for either penetrating or other blunt injury mechanism.
By TRISS methodology, unpredicted outcomes occurred in 56 of 255 patients(22% ) with 1 unpredicted death and 55 unpredicted survivors.
The sensitivity and specificity of TRISS Ps were 93% and 77%.
Performance outcome using the TRISS methodology revealed Z score for nonsurvivors of ㅡ 2.03, MVC injury of 2.42, other blunt injury of ㅡ 1.42 and penetrating injury of ㅡ 1.73
The results indicate that MVC patients were more severely injured than patients with other injury mechanisms and routine measurement of injury severity in patients with multiple trauma are essential for prediction of outcome and evaluation of trauma care.
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| Key words:
trauma severity indices |
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