Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Clinical and Research Institute of Emergency Children’s Surgery and
Trauma, Moscow, RussiaRussian National Research Medical
University, Moscow, Russia
Prognostic scales ISS-RTS-TRISS and APACHE II in
decision support for treatment of children with
trauma
Irina V. Vasilyeva, Sergei B. Arseniev Ph.D. , Sergey L.Shvirev Ph.D. , Zarubina T.V.
M.D.
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Modern health care in children's traumatology is directed to:
• Prevention of trauma causes • Timely rendering of medical care• Objective assessment of trauma severity
for treating patients with trauma • Effective decision-making to select an
adequate tactics of treatment • Justified distribution of resources in a
medical institution
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Objective estimation of trauma severity is based on:
• objective estimation of injury severity • objective estimation of patient’s state after
trauma . This estimation has been done using ISS-RTS-TRISS (Boyd and colleagues in 1987), APACHE II (Knaus et al., 1985) and other scales.
These scales allow to have an objective understanding of patient’s state severity and to find out an expected risk for death outcome
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Prognostic scales also allow:
• to sort patients by injury severity• to prescribe an adequate medical
treatment for trauma patients• to define the tactics of medical care for
such patients
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Research Goal:
To study the effectiveness of these scales in supporting doctor’s decision while choosing tactics for treating children with severe mechanical trauma and to study a possibility to integrate the studied methodology into Hospital Information System MEDIALOG
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Materials:
• Retrospective study• 399 patients with trauma ( November 2009 -
December 2011)• Average age 9 ± 5 year• 259 males (64,9%)• 26 died (6,5%)• Findings of anamnesis, initial examination,
parameters of physiological and neurological status at admission and within the first 24 hours.
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Criteria for including patients
Criteria for excluding patients
•Presence of heavy traumatic damage •Age up to 18•Staying in the anesthesiology and resuscitation department not less than twelve hours.•Availability of all necessary data for calculating results of prognostic scales
•Signs of drowning •Injuries received as a result of acute blood circulation disorders (ex.: rupture of vascular aneurysms)•Gun-shot wounds•Repeated admission to anesthesiology and resuscitation department
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Research methods:
• Integration of prognostic scales into HIS environment
• Statistical assessment and statistical description in Excel and SPSS programs
• Evaluation of discrimination ability (ROC-curve)
• Evaluation of calibration ability (c-criterion of Hosmer-Lemeshow )
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Distribution of Probability for Death Outcomes
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Research results of prognostic scales
Prognostic scales ROC-curve c-criterion of Hosmer-Lemeshow
Az p
ISS-RTS-TRISS 0,908±0,029 0,951
APACHE II 0,875±0,038 0,012
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Area under ROC- curve
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Conclusion
• The automated calculation of scale parameters in Health Informatics System (HIS) has shown that the discussed technique is a quick and operative instrument for supporting clinical decision so as to reduce death outcomes in children with trauma.
• Our research has shown that ISS-RTS-TRISS prognostic scale has an outstanding discrimination ability and a significant calibration ability which can be used for prognostic assessment of outcomes in children with trauma. In spite of the fact that these APACHE II prognostic scale has shown an excellent discrimination ability, the calibration ability was not significant. Thus, ISS-RTS-TRISS scale can be recommended for assessing severity of injuries in children
Irina Vasilyeva, Moscow, Russia
Russian National Research Medical University Clinical and Research Institute of Emergency Children’s Surgery and
Trauma
Thank you for attention!
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