Primary verification: is the TRISS appropriate for Thailand?

Area of Science:

• Trauma Care Research
• Injury Epidemiology
• Public Health

Background:

• The Trauma and Injury Severity Score (TRISS) is a standard for evaluating trauma care quality in the US.
• Its applicability to diverse populations, like road traffic injury (RTI) patients in Thailand, requires validation.

Purpose of the Study:

• To assess the effectiveness of the TRISS model in evaluating trauma care and classifying outcomes for severe blunt road traffic injury patients in Thailand.
• To compare the TRISS model's performance in Thailand with its established benchmarks from the American Major Trauma Outcome Study (MTOS).

Main Methods:

• Retrospective analysis of Thailand's Injury Surveillance System database (1996) for severe blunt RTI patients.
• Application of the TRISS model to calculate patient survival probabilities.
• Chi-square goodness-of-fit test to compare survival probability distributions between Thai and US trauma cohorts.
• Evaluation of TRISS prediction accuracy, sensitivity, and specificity.

Main Results:

• Significant differences (p < 0.00001) were observed in the survival probability distribution between American trauma patients and Thai RTI patients.
• The TRISS model demonstrated high accuracy and sensitivity but low specificity in predicting survival for Thai RTI patients.
• Factors such as Revised Trauma Score (RTS), Injury Severity Score (ISS), and age distributions differed between the MTOS and Thai RTI cohorts, influencing survival probability.

Conclusions:

• The TRISS model, while accurate and sensitive, exhibits low specificity for predicting outcomes in Thai road traffic injuries, yielding a high rate of false positives.
• Significant demographic and injury characteristic disparities between US and Thai trauma populations limit the direct application of TRISS without adjustments.
• Further research is needed to refine trauma outcome prediction models for specific regional contexts like Thailand.