损伤严重程度评分应用现状

The Application of Injury Severity Scoring Systems

目的分析四种常用损伤严重程度评分方法的应用现状,提高医务人员对损伤严重程度评分方法的熟悉程度和应用效果。方法总结归纳近年来国内外关于损伤严重程度评分方法的相关研究文献。结果四种常用损伤严重程度评分方法在应用中各有优缺点。损伤严重程度评分(ISS)是目前评价损伤严重程度较为通用的标准,但是对多发伤评估效果差,且需要知道所有准确的解剖伤情况;基于ICD的损伤严重程度评分(ICISS)允许所有伤参与伤情的预测,提高伤员预后的预测准确性,对医务人员不需要特别的训练和经验,但是各医院之间的ICD-9编码存在差异,且ICISS容易高估一些小伤;新的损伤严重程度评分(NISS)克服了ISS受解剖区域限制的缺陷,预测能力比ISS强,但是要求创伤专家提供准确的简明损伤定级标准(AIS)值;创伤严重程度评分(TRISS)结合解剖和生理双重指标,使大小不等的创伤中心之间的比较成为可能,同时还能用于儿童创伤患者的预后判断,但是需要一定的知识和训练理解复杂的统计术语,需要专业的创伤登记获得相关计算数据。结论一方面应加强损伤严重程度评分方法的优化,探索更标准化适应面更广的模型,另一方面应结合地区特点正确理解并合理利用这些方法,以提高创伤救治效果。

Objective To analysis the application of four kinds of widely used injury severity scoring methods,and make medical personnel know well of them and use them appropriately. Methods The relevant research literature on the current situation of injury severity scoring systems in recent years were collected and summarized.Results The four kinds of widely used injury severity scoring methods all have strengths and weaknesses. Injury severity score（ ISS） is a national standard for assessing injury severity,but it decreases its ability to assess injury severity in patients with multiple injuries and cannot be truly calculated until all the exact anatomic injuries are known. International classification of disease- 9- basedinjury severity score（ ICISS） improves the accuracy of prediction by allowing all injuries to contribute to the prediction and does not require special training or expertise,but there is variability of ICD- 9 code used between hospitals and it often overestimates trivial injury. New injury severity score（ NISS） provides better predictive ability than ISS by taking the three highest scores regardless of anatomic area,but it requires a trauma specialist to provide an accurate Abbreviated injury scale（ AIS） scoring. Trauma score and injury severity score（ TRISS） combines the anatomical and physiological criteria,makes the comparisons between trauma centers possible regardless of size,and can predicts outcomes in pediatric trauma patients,but it needs knowledge and training to understand the complicate statistical terms and requires dedicated trauma registries to obtain data for calculation. Conclusion On one hand,we should optimize the injury severity score systems,explore a more standardized model which can be used more widely. On the other hand,we should consider the characteristics of the region and have a proper understanding and rational use of these methods in order to improve trauma rescue effects.